# An ICU client with severe ARDS has PaO2/FiO2 ratio 95 on FiO2 100 percent and PEEP 14. The team prepares to initiate prone positioning. Which monitoring action is most important during proning?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375057&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: ROR

## Question

An ICU client with severe ARDS has PaO2/FiO2 ratio 95 on FiO2 100 percent and PEEP 14. The team prepares to initiate prone positioning. Which monitoring action is most important during proning?

## Option

1. Confirm ETT depth and patency before, during, and after the turn **✔ Correct answer**
2. Discontinue sedation to allow neurologic assessment during prone
3. Reduce PEEP to facilitate the position change
4. Limit prone position to under 4 hours to prevent injury

**Correct answer: 1**

## Explanation

Prone positioning in severe ARDS (P/F under 150 on adequate PEEP) for at least 16 hours per session reduces mortality (PROSEVA trial). The most catastrophic complication is unplanned extubation or ETT displacement during the turn. The nurse must confirm ETT position and security before the turn, designate one team member to control the airway during the turn, and reconfirm bilateral breath sounds and ETT depth after. Sedation and paralysis are CONTINUED to prevent ventilator dyssynchrony. PEEP is maintained or increased — not reduced. Sessions are 16+ hours, not under 4.

## In-depth explanation

Pressure injury prevention: pillows under chest/pelvis/legs, free-floating abdomen, repositioning of head/arms every 2 hours (swimmer position).

## Clinical scenario

Sedated and paralyzed. ETT secured. Skin intact. Hemodynamically stable on norepinephrine.

## Key concepts

- **ARDS** — Acute Respiratory Distress Syndrome; bilateral infiltrates and hypoxia from inflammatory injury.
- **P/F ratio** — PaO2/FiO2; ARDS severity: mild 200-300, moderate 100-200, severe under 100.
- **PROSEVA trial** — Landmark RCT showing mortality benefit of prone positioning in severe ARDS.

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