NCLEX-RNPhysiological AdaptationHard
A nurse is caring for a client receiving mechanical ventilation for acute respiratory distress syndrome (ARDS). Which ventilator strategy is most consistent with current lung-protective guidelines?
- AHigh tidal volumes with high FiO2
- BHigh tidal volumes with low PEEP
- CLow tidal volumes with adequate PEEP
- DPermissive hyperventilation to normalize PaCO2
Show answer & explanationAnswer & explanation
Correct answer: C. Low tidal volumes with adequate PEEP
Lung-protective ventilation for ARDS uses low tidal volumes (approximately 6 mL/kg of predicted body weight) with adequate PEEP to prevent alveolar collapse and minimize ventilator-induced lung injury, while permitting mild hypercapnia (permissive hypercapnia, not hyperventilation).
Why the other options are wrong
- A. High tidal volumes are contraindicated; high FiO2 also risks oxygen toxicity.
- B. High tidal volumes worsen alveolar overdistension and lung injury in ARDS.
- D. Permissive hypercapnia (allowing elevated CO2), not hyperventilation, is the accepted strategy.
ARDS Lung-Protective Ventilation
Ventilator strategy using low tidal volumes and adequate PEEP to minimize further lung injury in ARDS.
- Tidal volume target ~6 mL/kg predicted body weight
- PEEP keeps alveoli open, improves oxygenation
- Permissive hypercapnia is acceptable trade-off
- Goal is to reduce ventilator-induced lung injury
Memory trick: Low and Slow protects the alveoli