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Emergency and Critical Care Nursing

Acute Respiratory Distress (ARDS) Practice Questions

14 free Acute Respiratory Distress (ARDS) practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 14 Hard

Which of the following best describes ARDS?

  1. A Cardiogenic pulmonary edema from elevated left atrial pressure
  2. B Non-cardiogenic pulmonary edema with acute hypoxemia and bilateral infiltrates
  3. C A chronic restrictive lung disease with gradual progression
  4. D A pure airway disease confined to the conducting bronchi

Correct answer: Non-cardiogenic pulmonary edema with acute hypoxemia and bilateral infiltrates

ARDS is characterised by acute onset, bilateral lung infiltrates, severe hypoxemia not explained by cardiac failure or fluid overload.

Question 2 of 14 Medium

A key component of ARDS pathophysiology is:

  1. A Reduced capillary permeability producing only mild edema
  2. B Alveolar-capillary membrane injury leaking protein-rich fluid into alveoli
  3. C Primary airway narrowing driven by reversible bronchospasm
  4. D Raised left ventricular pressure causing hydrostatic pulmonary edema

Correct answer: Alveolar-capillary membrane injury leaking protein-rich fluid into alveoli

ARDS involves damage to alveolar epithelium and capillary endothelium, increased permeability, non-cardiogenic edema and reduced lung compliance.

Question 3 of 14 Medium

What is a risk factor for developing ARDS?

  1. A An isolated, mild, self-limiting asthma exacerbation
  2. B Sepsis, aspiration, major trauma, or massive transfusion
  3. C Well-controlled chronic COPD on stable therapy
  4. D An uncomplicated viral upper respiratory infection

Correct answer: Sepsis, aspiration, major trauma, or massive transfusion

ARDS often develops after a precipitating event such as sepsis, massive transfusion, aspiration, pneumonia or trauma.

Question 4 of 14 Hard

In the emergency nursing care of a patient with suspected ARDS, what is the initial management priority?

  1. A Deliver high tidal volumes to normalise PaCO2 at once
  2. B Treat the underlying cause while giving oxygen and lung-protective ventilation
  3. C Withhold oxygen until the chest X-ray is definitive
  4. D Start inhaled nitric oxide as first-line therapy for all cases

Correct answer: Treat the underlying cause while giving oxygen and lung-protective ventilation

Early care includes identifying triggers (e.g., aspiration), ensuring adequate oxygenation, and applying lung-protective ventilation (low tidal volumes) rather than high volumes or delay.

Question 5 of 14 Medium

According to guidelines, which ventilatory strategy is recommended for ARDS to reduce mortality?

  1. A Tidal volumes above 10 mL/kg predicted body weight
  2. B Tidal volumes of 6 mL/kg PBW with plateau pressure under 30 cm H2O
  3. C Zero positive end-expiratory pressure throughout ventilation
  4. D Routine high-frequency oscillatory ventilation for every patient

Correct answer: Tidal volumes of 6 mL/kg PBW with plateau pressure under 30 cm H2O

Evidence strongly supports low tidal volume ventilation (<6 mL/kg PBW) with plateau pressure <30 cm H₂O to reduce mortality in ARDS.

Question 6 of 14 Medium

Which intervention has been shown to improve outcomes in moderate to severe ARDS?

  1. A Routine use of inhaled nitric oxide in all patients
  2. B Prone positioning for 12-16 hours daily when not contraindicated
  3. C Deliberate fluid overloading to raise cardiac output
  4. D Strict avoidance of neuromuscular blockade in every case

Correct answer: Prone positioning for 12-16 hours daily when not contraindicated

Prone positioning in selected patients with moderate/severe ARDS improves oxygenation and is recommended in evidence-based guidelines.

Question 7 of 14 Medium

A patient in the ED has suspected aspiration of gastric contents. What is correct about aspiration and lung injury?

  1. A Aspiration events almost always resolve without complication
  2. B Gastric aspiration can cause chemical pneumonitis that may progress to ARDS
  3. C Aspirated food invariably produces immediate bacterial pneumonia
  4. D Aspiration has essentially no link to the development of ARDS

Correct answer: Gastric aspiration can cause chemical pneumonitis that may progress to ARDS

Aspiration of acidic or oropharyngeal contents may cause chemical pneumonitis and can lead to ARDS in some cases.

Question 8 of 14 Medium

Which of the following nursing actions is most appropriate immediately after suspected aspiration in a semi-conscious patient?

  1. A Lay the patient flat and postpone airway assessment
  2. B Elevate the head of the bed, suction, monitor SpO2, and prepare to intubate
  3. C Withhold oxygen until arterial blood gas results return
  4. D Give broad-spectrum antibiotics before securing the airway

Correct answer: Elevate the head of the bed, suction, monitor SpO2, and prepare to intubate

After aspiration, airway protection, oxygenation and suction are immediate priorities; delaying these increases risk of hypoxia and progression to ARDS.

Question 9 of 14 Hard

Which lab/monitoring result would most clearly indicate worsening ARDS?

  1. A A PaO2/FiO2 ratio rising above 300 on stable settings
  2. B A PaO2/FiO2 ratio falling below 200 despite increased FiO2
  3. C Clear chest imaging with normal oxygenation indices
  4. D Preserved, near-normal static lung compliance

Correct answer: A PaO2/FiO2 ratio falling below 200 despite increased FiO2

A hallmark of ARDS is worsening hypoxemia reflected in a low PaO₂/FiO₂ ratio (e.g., <200) despite high FiO₂ and supportive care.

Question 10 of 14 Medium

A nurse recognises the importance of fluid management in ARDS. Which strategy is supported by current evidence?

  1. A Liberal fluid loading to maximise perfusion regardless of lung status
  2. B Conservative fluid balance after adequate initial resuscitation
  3. C Strict fluid restriction with no intake until ARDS resolves
  4. D Routine first-line diuresis before assessing hemodynamics

Correct answer: Conservative fluid balance after adequate initial resuscitation

Conservative fluid strategies in ARDS (after initial resuscitation) help reduce lung edema and improve ventilator-free days and outcomes.

Question 11 of 14 Medium

When caring for a mechanically ventilated ARDS patient, how can the risk of ventilator-associated lung injury (VILI) be reduced?

  1. A Apply high tidal volumes with high inspiratory pressures
  2. B Use low tidal volumes, limit plateau pressure, and apply appropriate PEEP
  3. C Withhold sedation so the patient overrides the ventilator
  4. D Disregard patient-ventilator synchrony during weaning

Correct answer: Use low tidal volumes, limit plateau pressure, and apply appropriate PEEP

Reducing ventilator-induced lung injury in ARDS involves protective ventilation strategies—low tidal volume, pressure limitation, PEEP optimization.

Question 12 of 14 Easy

Which of the following is a key nursing diagnosis relevant to aspiration risk?

  1. A Impaired urinary elimination related to retention
  2. B Risk for aspiration related to a decreased gag and swallow reflex
  3. C Excess fluid volume related to sodium and water retention
  4. D Ineffective peripheral tissue perfusion related to venous stasis

Correct answer: Risk for aspiration related to a decreased gag and swallow reflex

Impaired gag/swallow reflex and altered consciousness predispose to aspiration—nurses must recognise risk for aspiration diagnosis and implement preventive strategies.

Question 13 of 14 Medium

In a patient with ARDS undergoing prone positioning, what is the most important nursing consideration?

  1. A Leave all vascular and airway lines unsecured during the turn
  2. B Protect the airway and lines and watch for pressure areas and facial edema
  3. C Avoid repositioning for 24 hours regardless of the tubing
  4. D Remove the endotracheal tube before turning the patient prone

Correct answer: Protect the airway and lines and watch for pressure areas and facial edema

Prone positioning requires careful attention to airway security, line stability, pressure injury prevention, and monitoring for complications.

Question 14 of 14 Hard

A patient in ARDS with PaO₂/FiO₂ ratio of 120 despite high PEEP and low tidal volume ventilation might require which advanced intervention?

  1. A Abruptly discontinue mechanical ventilation altogether
  2. B Consider extracorporeal membrane oxygenation as salvage therapy
  3. C Switch to high tidal volumes to drive down CO2
  4. D Remove PEEP and sharply reduce the FiO2

Correct answer: Consider extracorporeal membrane oxygenation as salvage therapy

In severe refractory hypoxemia ARDS, ECMO may be considered per guideline as rescue therapy when conventional lung-protective strategies fail.

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