Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition 

Chapter 27: Acute Lung Injury, Pulmonary Edema, and Multiple System Organ 

Failure Test Bank  

MULTIPLE CHOICE  

1. Distinguishing between hydrostatic and non-hydrostatic pulmonary edema is often difficult, 

even for skilled clinicians.  
a. True  
b. False  

2. The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained 
stable over the past three decades.  
a. True  
b. False  

3. Which of the following is not a risk factor for ARDS?  

a. viral pneumonia  
b. gastric aspiration  
c. near-drowning  
d. diabetes  

4. Which of the following factors are associated with a higher risk for ARDS? 
1. gastric aspiration  
2. multiple transfusions  
3. septic shock 
4. burn injury  
a. 1 and 3  
b. 2 and 4  
c. 1, 2, 3, and 4  
d. 3  

5. According to the Starling’s equation, which forces influence the movement of fluid from the 
bloodstream to the interstitium?  
1. microvascular hydrostatic pressure  
2. interstitial osmotic pressure  
3. microvascular osmotic pressure  
4. interstitial hydrostatic pressure  
a. 1  
b. 1 and 2  
c. 3 and 4  
d. 1 and 4  

 
 6. Which of the following systems is the primary operant to rid the body of fluid accumulation in 
non-pathologic conditions?  
a. respiratory  
b. cardiac  
c. lymphatic  
d. renal  
7. Which of the following risk factors for ARDS is classified as a nonpulmonary cause? 
a. toxic inhalation 
b. gastric aspiration  
c. near drowning  
d. sepsis  

8. Which of the following mechanisms ultimately leads to ARDS regardless of the etiology? 
a. disruption of the endothelial and epithelial barriers  
b. alveolar flooding  
c. interstitial damage  
d. increased oncotic pressure  

9. Which of the following terms describes programmed cell death?  

a. osmosis  
b. apoptosis  
c. mitosis  
d. necrosis  

10. Which of the following white blood cells is most commonly implicated in the inflammatory 
process of ARDS?  
a. eosinophils  
b. monocytes  
c. neutrophils  
d. lymphocytes  
 
11. Which of the following clinical features is often common to both ARDS and congestive heart 
failure (CHF)?  
a. BALF is proteinaceous and inflammatory  
b. diffuse alveolar and interstitial infiltrates in chest radiograph  
c. pleural effusions on chest radiograph  
d. recent history of trauma  
12. Which of the following organs play​s a​ major role in induction and modulation of the systemic 
inflammatory response?  
a. heart  
b. brain  
c. kidneys  
d. liver  

 
13. What time does the exudative phase of ARDS typically presents?  
a. between days 1 and 3  
b. between days 4 and 7  
c. after 1 week  
d. after 1 month  

14. Which of the following is not a common finding in the exudative phase of ARDS? 
a. dyspnea  
b. bradypnea  
c. refractory hypoxemia  
d. tachypnea  

15. What is the name of the period that follows the exudative phase in ARDS? 
a. fibroproliferative  
b. fibrotic  
c. proliferative  
d. intraalveolar  

16. Which of the following assessment tools is most useful in distinguishing ARDS from CHF? 
a. chest radiograph  
b. arterial blood gas  
c. Swan-Ganz catheter  
d. pulmonary function testing  

17. Which of the following tests provides useful information in making the diagnosis of ARDS 
for patients with inconclusive results on traditional tests?  
a. examination of bronchoalveolar lavage fluid (BALF)  
b. measurement of mixed venous oxygen level  
c. measurement of total white blood-cell count  
d. ventilation/perfusion ratio ( ) scanning  

18. Which of the following parameters is important in determining the optimal level of positive 
end-expiratory pressure (PEEP) in a patient with ARDS?  
a. PaO​2  
b. SaO​2  
c. DO​2 
d. CaO​2  

19. What is recommended in terms of fluid management of patients with ARDS? 

a. conservative  
b. aggressive volume replacement  
c. increased dieresis  
d. only administer colloids  

 
20. Which of the following parameters are important in the management of patients with ARDS? 
1. Keep systolic blood pressure below 90 mm Hg.  
2. Keep hemoglobin saturation above 90%.  
3. Ensure adequate urine output.  
4. Keep mean arterial pressure above 60 mm Hg.  
a. 1  
b. 1 and 4  
c. 2, 3, and 4  
d. 1, 2, 3, and 4  

21. The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size. 
a. True  
b. False  

22. Which of the following benefits has not been associated with the use of PEEP in a patient with 
ARDS?  
a. reduced work of breathing  
b. lowered FIO​2  
c. increased functional residual capacity (FRC)  
d. improved venous return  

23. Which of the following complications has been associated with the use of PEEP in patients 
with ARDS?  
a. lung infection  
b. reduced cardiac output  
c. hepatic failure  
d. myocardial infarction  

24. What ventilatory strategy has been found to be useful for avoiding barotrauma in the 
treatment of patients with ARDS?  
a. prolonged expiratory time  
b. permissive hypercapnia  
c. inverse-ratio ventilation  
d. intermittent mandatory ventilation  

25. What range is now recommended for tidal volumes (V​T​) in a patient with ARDS who is being 
mechanically ventilated?  
a. 3 to 5 ml/kg  
b. 6 to 10 ml/kg  
c. 10 to 12 ml/kg  
d. 13 to 15 ml/kg  

26. What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar 
collapse while using small tidal volumes in patients with ARDS?  
a. inverse-ratio ventilation  
b. high-frequency ventilation (HFV)  
c. intermittent mandatory ventilation  
d. airway pressure-release ventilation  
27. What is the maximal inspiratory pressure that should be targeted when using pressure control 
ventilation in patients with ARDS?  
a. 20 to 25 cm H​2​O  
b. 25 to 30 cm H​2​O  
c. 30 to 35 cm H​2​O  
d. 35 to 40 cm H​2​O  

28. What mode of mechanical ventilation is designed to optimize ventilation by recruiting 

alveolar units while minimizing ventilator-induced barotrauma in patients with 
ARDS? a. inverse-ratio ventilation  
b. high-frequency ventilation  
c. intermittent mandatory ventilation 
d. airway pressure-release ventilation (APRV)  

29. Which of the following statements is true about prone-positioning of patients with ARDS? 
a. It produces a transient improvement in gas exchange.  
b. It dramatically reduces the mortality of patients with ARDS.  
c. It does not require experienced staff.  
d. It does not improve gas exchange at all.  

30. The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients 
with ARDS is not recommended at this time.  
a. True  
b. False  

31. What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might 
be useful?  
a. elevated CO​2 ​levels in arterial blood gases  
b. severe elevation of pulmonary vascular resistance  
c. severe increases in the work of breathing  
d. bronchoconstriction as evidenced by wheezing  
32. Although promising, inhaled NO remains an experimental therapy for patients with ARDS. 
a. True 
b. False  

33. The basis for permissive hypercapnia as a ventilator strategy for ARDS is explained by which 
of the following?  
a. Introduction of CO2 into the breathing circuit to stimulate spontaneous breaths 
b. use of lower tidal volumes and accepting a gradual rise in PCO​2 to
​ avoid 
associated hazards of high P​aw  
c. allow patients with ARDS to breathe spontaneously to build their respiratory 
muscular endurance  
d. to use exhaled CO​2 to
​ increase residual volume and improve gas exchange