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1. Question
The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome?
Correct
Option D is the correct answer:
Rationale: The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.
Test-Taking Strategy: Note the strategic word, earliest. Eliminate option 3 first, because intercostal retraction is a later sign of respiratory distress. Of the remaining options, recall that adventitious breath sounds (options 1 and 2) would occur later than an increased respiratory rate.
Incorrect
Option D is the correct answer:
Rationale: The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.
Test-Taking Strategy: Note the strategic word, earliest. Eliminate option 3 first, because intercostal retraction is a later sign of respiratory distress. Of the remaining options, recall that adventitious breath sounds (options 1 and 2) would occur later than an increased respiratory rate.
Acute respiratory distress syndrome (ARDS; previously called adult respiratory distress syndrome) is a clinical syndrome characterized by a sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia refractory to oxygen supplementation, and reduced lung compliance. These signs occur in the absence of left-sided heart failure.
Patients with ARDS usually require mechanical ventilation with a higher-thannormal airway pressure. A wide range of factors are associated with the development of ARDS , including direct injury to the lungs (eg, smoke inhalation) or indirect insult to the lungs (eg, shock). ARDS has been associated with a mortality rate as high as 50% to 60%. The major cause of death in ARDS is nonpulmonary multiple-system organ failure, often with sepsis.
