Progressive Care Nursing Certification (PCCN) Practice Exam

What is the most appropriate intervention to prevent acute respiratory distress syndrome in a patient with a respiratory infection and blunt trauma?

1. Prophylactic mechanical ventilation with large tidal volumes

2. Minimizing transfusion of packed red blood cells

3. Measures to keep patient pH 7.25-7.35

4. Withholding antibiotic therapy until organism identification

The correct answer is: Minimizing transfusion of packed red blood cells

Minimizing the transfusion of packed red blood cells is the most appropriate intervention to prevent acute respiratory distress syndrome (ARDS) in this scenario. In patients who have experienced blunt trauma and are at risk for developing ARDS, the use of blood products, particularly packed red blood cells, can lead to complications such as transfusion-related acute lung injury (TRALI) or increase inflammatory mediators that can exacerbate pulmonary dysfunction. Transfusions can provoke an immune response and contribute to fluid overload, both of which can worsen respiratory function. By limiting the use of packed red blood cells, the risk factors that contribute to the development of ARDS can be reduced. Keeping hemoglobin levels sufficient while avoiding unnecessary transfusions is crucial in managing a patient who is already compromised by a respiratory infection and trauma. The other options do not effectively address the prevention of ARDS in the context provided. Prophylactic mechanical ventilation with large tidal volumes can cause volutrauma and worsen lung injury rather than prevent ARDS. Maintaining a pH range between 7.25 and 7.35 may not be beneficial in preventing ARDS, as maintaining correct acid-base balance alone is not enough for lung protection. Withholding antibiotic therapy until organism identification risks worsening the respiratory