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Quizzes > Health & Medicine > Diseases & Conditions

Master ARDS NCLEX Questions - Take the Free Quiz!

Ready for acute respiratory distress syndrome NCLEX questions? Challenge yourself now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration shows lungs ventilator IV bag on sky blue background for ARDS NCLEX quiz.

Craving a quick confidence boost before test day? Dive into our free ards nclex questions quiz to challenge your grasp of acute respiratory distress syndrome. You'll practice critical fluid management scenarios, ventilation strategies, and prioritization skills found in real-world settings, with instant feedback to pinpoint growth areas. Perfect for nursing students eyeing NCLEX success, this interactive NCLEX respiratory system quiz gives you targeted acute respiratory distress syndrome nclex questions and ards nursing exam questions to reinforce learning. Ready to sharpen your decision-making and ace these nclex ards practice questions? Let's get started - your path to excellence begins now!

According to the Berlin definition, ARDS onset must occur within what time frame after a known clinical insult?
Within one week
Within two weeks
Within 24 hours
Within one month
The Berlin definition specifies that acute respiratory distress syndrome must develop within one week of a known clinical insult or new/worsening respiratory symptoms. Onset beyond seven days excludes ARDS under this classification. Early identification within this window guides prompt management strategies. ATS Journals
Which PaO2/FiO2 ratio is used to define the presence of ARDS?
?500 mm Hg
?300 mm Hg
?400 mm Hg
?200 mm Hg
A PaO2/FiO2 ratio of 300 mm Hg or less on PEEP ?5 cm H2O is required to diagnose ARDS per the Berlin criteria. This metric quantifies hypoxemia severity. Ratios below 200 and 100 further classify moderate and severe disease. ATS Journals
What is the hallmark pathological finding in the lungs of a patient with ARDS?
Interstitial fibrosis
Bronchial hyperplasia
Diffuse alveolar damage
Pulmonary emboli
Diffuse alveolar damage is the characteristic histopathological lesion in ARDS, featuring hyaline membranes and alveolar epithelial injury. It distinguishes ARDS from other inflammatory or fibrotic lung diseases. Recognition guides prognostication and experimental therapies. NCBI PMC
On chest radiograph, ARDS typically presents with which finding?
Tension pneumothorax
Unilateral consolidation
Bilateral infiltrates
Pleural plaques
Bilateral alveolar infiltrates not fully explained by effusions, lobar collapse, or nodules are a radiographic hallmark of ARDS. They reflect diffuse lung injury and capillary leak. Unilateral or focal patterns suggest other diagnoses. American Thoracic Society
Which of the following is the most common precipitating risk factor for ARDS?
Asthma
Anemia
Sepsis
Gastroesophageal reflux
Sepsis is the leading risk factor for ARDS, accounting for up to 40% of cases. The systemic inflammatory response and endothelial injury in sepsis precipitate capillary leak in the lungs. Other triggers include pneumonia and aspiration. NCBI PMC
What is the primary purpose of applying positive end-expiratory pressure (PEEP) in ARDS ventilation?
Reduce tidal volume
Prevent alveolar collapse at end-expiration
Eliminate the need for FiO2
Increase peak airway pressure
PEEP maintains alveolar recruitment by preventing end-expiratory collapse, improving functional residual capacity and oxygenation. It reduces atelectrauma by stabilizing airspace during the respiratory cycle. Excessive PEEP, however, can impair hemodynamics. ATS Journals
What tidal volume strategy is recommended for lung-protective ventilation in ARDS?
10 mL/kg actual body weight
8 mL/kg ideal body weight
6 mL/kg predicted body weight
12 mL/kg predicted body weight
Low tidal volume ventilation using 6 mL/kg of predicted body weight reduces ventilator-induced lung injury and improves survival in ARDS. Higher volumes increase overdistension and barotrauma. This strategy is a core component of lung-protective ventilation. NEJM
In ARDS management, plateau airway pressure should be kept below which threshold to reduce barotrauma?
< 30 cm H2O
< 50 cm H2O
< 20 cm H2O
< 40 cm H2O
Maintaining plateau pressures below 30 cm H2O is essential to minimize barotrauma and overdistension in ARDS patients. Pressures above this threshold correlate with increased lung injury and mortality. Monitoring plateau pressure guides ventilator adjustments. ATS Journals
Which fluid management strategy is generally recommended for patients with established ARDS?
Conservative fluid management
Liberal fluid administration
No fluid monitoring
Immediate aggressive diuresis in all cases
A conservative fluid management approach aiming for neutral to negative fluid balance improves lung function and shortens mechanical ventilation in ARDS. It reduces extravascular lung water without compromising perfusion. Liberal fluids can exacerbate pulmonary edema. NEJM
Moderate ARDS is classified by a PaO2/FiO2 ratio within which range?
200 - 300 mm Hg
300 - 400 mm Hg
100 - 200 mm Hg
50 - 100 mm Hg
The Berlin definition categorizes moderate ARDS when PaO2/FiO2 is between 100 and 200 mm Hg on PEEP ?5 cm H2O. Mild ARDS is 200 - 300, and severe is ?100 mm Hg. These gradations help guide therapy intensity. ATS Journals
How does prone positioning improve oxygenation in ARDS patients?
Blocks inflammatory cytokines in alveoli
Decreases cardiac output to reduce shunt
Increases intra-abdominal pressure to inflate lungs
Redistributes perfusion to better-ventilated dorsal lung regions
Prone positioning redistributes blood flow to dorsal lung regions that are better ventilated, improving V/Q matching and oxygenation in ARDS. It also homogenizes pleural pressures, reducing ventilator-induced lung injury. Benefits are most pronounced in severe ARDS. NEJM
Which best describes a lung recruitment maneuver in ARDS management?
Rapid infusion of IV fluids to expand lung volume
Gradual decrease of PEEP to evaluate compliance
Sustained increase in airway pressure to open collapsed alveoli
High-frequency chest physiotherapy only
Recruitment maneuvers transiently raise airway pressures (e.g., 30 - 40 cm H2O for 30 - 40 seconds) to reopen collapsed alveoli. This can improve oxygenation when used judiciously. Excessive pressures risk barotrauma and hemodynamic compromise. NCBI PMC
Neuromuscular blockade in early severe ARDS improves outcomes by which mechanism?
Reducing patient-ventilator dyssynchrony and oxygen consumption
Stimulating surfactant production
Increasing cardiac output
Accelerating diuresis
Early neuromuscular blockade reduces patient-ventilator dyssynchrony, lowers oxygen consumption, and can decrease ventilator-induced lung injury in severe ARDS. Trials have shown improved oxygenation and possible survival benefits. Prolonged use requires deep sedation and monitoring. NEJM
Permissive hypercapnia is used in ARDS to:
Prevent acidosis by adding bicarbonate
Allow lower tidal volumes and reduce lung injury
Maintain normal PaCO2 by increasing minute ventilation
Increase respiratory rate above 40 breaths/min
Permissive hypercapnia accepts elevated PaCO2 in order to use low tidal volumes and minimize ventilator-induced lung injury. Mild respiratory acidosis is tolerated unless contraindicated. Attempting to normalize CO2 may necessitate injurious volumes or pressures. NCBI PMC
Transpulmonary thermodilution methods (e.g., PiCCO) in ARDS are primarily used to measure:
Arterial oxygen content
Extravascular lung water
Central venous pressure
Pulse oximetry waveform
PiCCO uses transpulmonary thermodilution to quantify extravascular lung water (EVLW), reflecting pulmonary edema severity in ARDS. Monitoring EVLW supports fluid management and predicts outcomes. It is more precise than central venous pressure. Oxford Academic
Which diuretic is most commonly used in a conservative fluid strategy for ARDS patients?
Spironolactone
Hydrochlorothiazide
Mannitol
Furosemide
Furosemide, a loop diuretic, is preferred for conservative fluid management in ARDS due to its potent diuretic effect and rapid onset. It helps achieve net negative fluid balance and reduce pulmonary edema. Thiazides and potassium-sparing agents are less effective in this context. NEJM
Which element of the ventilator-associated pneumonia (VAP) bundle is key for ARDS patients?
Routine use of high tidal volumes
Mandatory deep sedation
Prolonged antibiotic prophylaxis
Elevation of the head of bed ?30°
Elevating the head of the bed ?30° reduces aspiration risk and lowers VAP incidence in ventilated patients, including those with ARDS. Other bundle elements include oral care and sedation vacations. Deep sedation and high tidal volumes increase complications. CDC
Extracorporeal membrane oxygenation (ECMO) in ARDS is indicated primarily for:
Refractory hypoxemia despite optimal ventilation
Hypercapnia easily corrected by increased minute ventilation
Stable oxygenation with plateau pressures <25
Mild ARDS with P/F >200
ECMO is reserved for severe, refractory hypoxemia (e.g., PaO2/FiO2 <80) despite optimal lung-protective ventilation and adjuncts. It provides gas exchange support while minimizing ventilator-induced lung injury. Early referral in severe cases can improve survival. NEJM
Driving pressure in ARDS ventilation is calculated as which of the following?
Plateau pressure minus PEEP
Mean airway pressure minus PEEP
Peak inspiratory pressure minus PEEP
Tidal volume divided by predicted body weight
Driving pressure (?P) is defined as plateau pressure minus PEEP and reflects the cyclic stress on the lungs. Lower driving pressures (<15 cm H2O) are associated with improved survival in ARDS. It integrates tidal volume and compliance information. ATS Journals
Which resuscitation fluid is least likely to exacerbate pulmonary edema in ARDS?
Hydroxyethyl starch
0.9% normal saline
Balanced crystalloid solution
5% albumin
Balanced crystalloids like Lactated Ringer's reduce endothelial dysfunction and chloride load compared to normal saline or starches, making them less likely to worsen pulmonary edema. Colloids have not shown consistent benefit and may increase capillary leak. NEJM
Which monitoring technique provides the most direct measurement of extravascular lung water in ARDS?
Central venous pressure monitoring
Transthoracic ultrasound
Transpulmonary thermodilution
Pulmonary artery catheter
Transpulmonary thermodilution, as used in PiCCO systems, directly measures extravascular lung water, providing a quantitative assessment of pulmonary edema. Pulmonary artery catheters estimate wedge pressures but do not directly quantify EVLW. Ultrasound is qualitative. Oxford Academic
Individualizing PEEP using esophageal pressure measurements primarily aims to:
Estimate transpulmonary pressure to prevent collapse or overdistension
Determine shunt fraction directly
Quantify pulmonary compliance without ventilation
Measure cardiac preload more accurately
Esophageal pressure monitoring estimates pleural pressure, allowing calculation of transpulmonary pressure (airway minus pleural) to set PEEP. This strategy helps avoid alveolar collapse at end-expiration and overdistension at end-inspiration. It tailors PEEP to individual mechanics. ATS Journals
Elevations in surfactant protein-D (SP-D) in bronchoalveolar lavage fluid indicate what in ARDS?
Elevated left atrial pressure
Increased alveolar neutrophil count
Type II pneumocyte injury and surfactant dysfunction
Improved alveolar fluid clearance
Surfactant protein-D is produced by type II pneumocytes, and its elevation in lavage fluid reflects epithelial injury and surfactant dysfunction characteristic of ARDS. It is a biomarker of alveolar damage. It does not measure hemodynamics directly. NCBI PMC
Inhaled nitric oxide is used in ARDS primarily because it:
Directly reduces alveolar edema
Selective pulmonary vasodilator improves V/Q matching
Stimulates surfactant production
Acts as a systemic vasodilator to reduce afterload
Inhaled nitric oxide selectively dilates pulmonary vessels in ventilated lung units, improving V/Q matching and oxygenation. It has minimal systemic vasodilatory effects. It does not address alveolar fluid clearance or surfactant synthesis. ATS Journals
Airway Pressure Release Ventilation (APRV) is characterized by:
Bi-level pressure changes every two hours
Mandatory volume-controlled breaths at high rate
Sustained high CPAP with brief releases for ventilation
Inverse I:E ratio with constant low PEEP
APRV provides continuous positive airway pressure with brief pressure release phases allowing ventilation and CO2 elimination. It maintains alveolar recruitment while permitting spontaneous breathing. It differs from inverse ratio ventilation and standard modes. NCBI PMC
Obese patients with ARDS often require higher PEEP because:
Decreased chest wall compliance increases alveolar collapse
They have higher functional residual capacity
Increased abdominal pressure raises cardiac output
They produce more surfactant
Obesity reduces chest wall compliance and functional residual capacity, promoting alveolar collapse at lower PEEP. Higher PEEP helps maintain recruitment in these patients. This strategy must be balanced against hemodynamic effects. ATS Journals
Excess fluid administration in ARDS increases right ventricular afterload by:
Reducing pulmonary vascular resistance
Lowering pulmonary artery pressure
Elevating pulmonary vascular congestion and pressure
Increasing left atrial compliance
Excessive fluids increase pulmonary capillary hydrostatic pressure, causing vascular congestion and elevated pulmonary artery pressures. This elevates right ventricular afterload and may precipitate RV failure. Conservative fluid strategies help mitigate this risk. NCBI PMC
Personalized PEEP titration using CT imaging aims to:
Measure pleural fluid collections
Identify recruitable lung tissue for optimal pressure
Quantify shunt fraction noninvasively
Assess cardiac chamber enlargement
CT-based PEEP titration assesses regional lung recruitment and overdistension, allowing clinicians to set PEEP where recruitable tissue is maximized without causing barotrauma. This personalized approach may improve outcomes but is resource-intensive. ATS Journals
Mesenchymal stem cell therapy in ARDS is being investigated for its ability to:
Directly replace damaged alveolar epithelium
Increase bacterial translocation
Modulate inflammation and promote alveolar repair
Potentiate ventilator-induced lung injury
Mesenchymal stem cells have immunomodulatory properties and may secrete factors that reduce inflammation and enhance alveolar epithelial repair in ARDS. Clinical trials are ongoing to determine safety and efficacy. They do not directly engraft as lung epithelium. ATS Journals
Which type of ventilator-induced lung injury results from repetitive alveolar opening and closing?
Biotrauma
Volutrauma
Atelectrauma
Barotrauma
Atelectrauma refers to injury caused by cyclic collapse and re-expansion of alveoli, leading to shear stress and inflammation. Volutrauma is overdistension, barotrauma is pressure injury, and biotrauma is inflammatory mediator release. Minimizing collapse with appropriate PEEP reduces atelectrauma. ATS Journals
In experimental ARDS, targeting which molecular pathway has been shown to reduce alveolar permeability?
Angiopoietin-1/Tie2 signaling
Beta-adrenergic receptor activation
Dopamine D2 receptor blockade
Epidermal growth factor receptor inhibition
Angiopoietin-1 signaling through Tie2 stabilizes endothelial junctions, reducing vascular leak and alveolar permeability in ARDS models. Therapeutic modulation of this pathway has shown promise in preclinical studies. Other pathways have not demonstrated comparable benefit. NCBI PMC
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Study Outcomes

  1. Interpret ARDS Pathophysiology -

    Understand the underlying mechanisms of acute respiratory distress syndrome to distinguish hallmark signs and symptoms in ARDS NCLEX questions.

  2. Apply Fluid Management Principles -

    Execute appropriate fluid balance interventions by evaluating fluid volume status and optimizing perfusion in ARDS nursing exam questions.

  3. Evaluate Ventilator Settings -

    Analyze mechanical ventilation parameters and adjust settings to minimize lung injury while maintaining adequate oxygenation in nclex ards practice questions.

  4. Assess Clinical Indicators -

    Identify key assessment cues such as arterial blood gas values, breath sounds, and vital signs to make informed decisions on acute respiratory distress syndrome nclex questions.

  5. Differentiate Nursing Interventions -

    Distinguish between priority nursing interventions, including positioning strategies and sedation management, to improve patient outcomes in ARDS NCLEX questions.

  6. Enhance Critical Thinking -

    Develop systematic problem”solving techniques to boost confidence and accuracy when tackling ARDS NCLEX questions.

Cheat Sheet

  1. Pathophysiology and Phases -

    ARDS begins with an inflammatory cascade that damages the alveolar - capillary membrane, increasing permeability and causing protein-rich fluid to flood alveoli. Remember the mnemonic "BALI" (Barrier leak, Alveolar collapse, Loss of compliance, Inflammatory exudate) to recall key changes in exudative, proliferative, and fibrotic phases (American Thoracic Society).

  2. Berlin Definition and Oxygenation Criteria -

    The Berlin definition classifies ARDS by timing (within 1 week of insult), imaging (bilateral opacities), and oxygenation: mild (PaO2/FiO2 200 - 300), moderate (100 - 200), severe (<100). For example, a PaO2 of 80 mmHg on FiO2 0.6 yields a ratio of 133, indicating moderate ARDS (ARDS Definition Task Force, JAMA 2012).

  3. Low Tidal Volume Ventilation -

    Follow the ARDSnet protocol: set tidal volume at 6 mL/kg predicted body weight and keep plateau pressures ≤30 cm H2O. Calculate PBW with formulas (men: 50 kg + 2.3 kg per inch over 5 ft) to avoid volutrauma (National Heart, Lung, and Blood Institute).

  4. Conservative Fluid Management -

    A conservative fluid strategy aiming for a negative balance reduces ventilator days and pulmonary edema. Target CVP 4 - 8 mmHg or PAOP 8 - 12 mmHg using daily assessments - think "CAFE" (Conservative therapy, Avoid FVE, Evaluate daily) to guide volume status (FACTT trial, NEJM 2006).

  5. Adjunct Therapies: Proning & Paralysis -

    Prone positioning ≥12 hours daily improves V/Q matching and survival in severe ARDS, while early neuromuscular blockade (e.g., cisatracurium) in the first 48 hours reduces ventilator-induced lung injury. Remember "PIP": Proning, Paralytics, Inhaled NO for refractory cases (PROSEVA trial, NEJM 2013).

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