The client who smokes two packs of cigarettes a day develops ARDS after a near-drowning. The client asks the nurse, 'What is happening to me? Why did I get this?' Which statement by the nurse is most appropriate?

Correct Answer: C

Rationale: The correct answer is C because it provides a clear and accurate explanation to the client's question. ARDS is characterized by fluid accumulation in the lungs, leading to breathing difficulties. This response directly addresses the client's concern about what is happening to their body. Choice A is incorrect as not all individuals who almost drown develop ARDS. Choice B is incorrect because it describes a mechanism of injury different from ARDS. Choice D is incorrect as smoking may increase the risk of developing ARDS but is not the direct cause in this scenario. In summary, choice C is the most appropriate response as it directly addresses the client's condition and explains the underlying cause of their breathing problems related to ARDS.

Correct Answer: A

Rationale: The correct answer is A: Hypercapnic respiratory failure related to decreased ventilatory effort. Barbiturates can depress the central nervous system, leading to decreased respiratory drive and effort, resulting in hypercapnia (elevated CO2 levels) and respiratory acidosis. This can progress to respiratory failure. The other choices are incorrect because hypoxemic respiratory failure related to diffusion limitations (B) or shunting of blood (C) are not typically associated with barbiturate overdose. Hypercapnic respiratory failure related to increased airway resistance (D) is also unlikely with barbiturate overdose, as the primary mechanism is central respiratory depression.

Correct Answer: C

Rationale: The correct answer is C: IV gentamicin (Garamycin) 60 mg. Gentamicin is a nephrotoxic medication and should be used with caution in patients with acute renal failure, as it can further impair kidney function. Before administering this medication, the nurse should discuss with the healthcare provider to evaluate the risks versus benefits and consider alternative options. A: IV ranitidine (Zantac) 50 mg IV - This medication is commonly used to reduce gastric acid secretion and is not contraindicated in a patient with ARDS and acute renal failure. B: sucralfate (Carafate) 1 g per nasogastric tube - Sucralfate is a mucosal protective agent and is not directly related to renal function. It is safe for use in patients with renal failure. D: IV methylprednisolone (Solu-Medrol) 40 mg - Methylprednisolone is a corticoster

Correct Answer: D

Rationale: The correct answer is D because NIPPV is appropriate for patients with respiratory failure due to myasthenia gravis to provide ventilatory support. Myasthenia gravis is a neuromuscular disorder that can lead to respiratory muscle weakness. NIPPV can help improve ventilation and oxygenation in these patients. Choice A is incorrect because NIPPV may not be suitable for patients with unstable cardiac output and blood pressure. Choice B is incorrect as NIPPV is not typically used for respiratory failure caused by head injury with loss of consciousness. Choice C is incorrect because NIPPV may not be the first-line intervention for cystic fibrosis patients with copious secretions.

Correct Answer: C

Rationale: The correct answer is C: white-out infiltrates bilaterally. In ARDS, chest x-ray typically shows diffuse bilateral infiltrates leading to a white-out appearance. This is due to widespread alveolar damage and flooding of alveoli with fluid. The other choices are incorrect because A (infiltrates only on the upper lobes) is not typical for ARDS, B (enlargement of the heart with bilateral lower lobe infiltrates) suggests congestive heart failure, and D (normal chest x-ray) would not be expected in a patient with deteriorating respiratory function like in ARDS.