A nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse identify as a manifestation of this syndrome?

An audible pleural friction rub

Tracheal deviation from the midline

Refractory hypoxemia

Bloody expectorant when coughing

Answer and Explanation

The Correct Answer is C

Rationale:
A. An audible pleural friction rub: A pleural friction rub is typically heard in conditions involving pleural inflammation, such as pleurisy or pericarditis. It is not a defining feature of acute respiratory distress syndrome, which primarily involves alveolar damage and pulmonary edema.

B. Tracheal deviation from the midline: Tracheal deviation is usually associated with a tension pneumothorax or large pleural effusion. ARDS does not typically cause tracheal shift, as it affects the lungs diffusely rather than exerting pressure on one side.

C. Refractory hypoxemia: This is a hallmark of ARDS. It refers to hypoxemia that does not improve significantly with supplemental oxygen due to impaired gas exchange from widespread alveolar-capillary membrane damage, leading to severe ventilation-perfusion mismatch.

D. Bloody expectorant when coughing: Hemoptysis (bloody sputum) can occur in various respiratory conditions but is not a characteristic manifestation of ARDS. In ARDS, secretions are more likely to be frothy and pink-tinged if pulmonary edema is present.

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Correct Answer is D

Explanation

Rationale:
A. Decreased WBC count: Bacterial meningitis causes an inflammatory response, leading to an increased WBC count in the cerebrospinal fluid (CSF), not a decrease. Elevated WBCs indicate the body is fighting infection in the central nervous system.

B. Increased glucose: CSF glucose levels are typically decreased because bacteria consume glucose and impair its transport across the blood-brain barrier. The presence of leukocytes and pathogens in the CSF also contributes to glucose depletion. Elevated glucose is not characteristic of this condition.

C. Clear cerebrospinal fluid: CSF in bacterial meningitis is usually cloudy or turbid due to the accumulation of white blood cells, protein, and bacteria. The change in appearance reflects the severity of the infection and is one of the classic diagnostic signs. Clear CSF would be more consistent with normal or viral findings.

D. Increased protein: A hallmark of bacterial meningitis is elevated CSF protein levels due to increased permeability of the blood-brain barrier and the presence of bacterial and inflammatory proteins. This is an expected finding.

A. Chest tube output B. Respiratory rate C. Trachea position D. Urine output E. O₂ saturation F. Blood pressure G. Heart rate H. Temperature

Correct Answer is ["A","C","E","F"]

Explanation

Rationale:

Chest tube output: A sudden stop in chest tube drainage following bright red output earlier can indicate tube obstruction or clot formation. This is concerning post-lobectomy, as blocked drainage may lead to tension pneumothorax or fluid accumulation.
Respiratory rate: A rate of 18/min is within normal limits and shows no signs of distress or compromise. Therefore, it does not require immediate reporting.
Trachea position: A shift from midline to deviated trachea suggests mediastinal shift, potentially due to a developing tension pneumothorax. This is a medical emergency and must be reported immediately.
Urine output: A urine output of 110 mL over one hour is well within normal limits and indicates adequate kidney perfusion. The expected minimum is 30 mL/hr, so this value does not raise concern for hypoperfusion or renal impairment. There is no need to report this finding to the provider at this time.
O₂ saturation: A drop from 92% to 89% on room air is clinically significant, especially after thoracic surgery. Hypoxia in this context may signal impaired lung function or emerging complications like pneumothorax.
Blood pressure: The client’s blood pressure dropped from 130/80 mm Hg to 110/60 mm Hg within one hour. While 110/60 mm Hg is still within normal range, the sudden 20 mm Hg drop in systolic pressure may indicate early hemodynamic instability, especially postoperatively.
Heart rate: A heart rate of 70/min is normal and stable, showing no signs of bradycardia or tachycardia that would warrant concern at this stage.
Temperature: A decrease in temperature from 37.2°C to 36.4°C is not clinically alarming postoperatively and does not suggest infection or hypothermia. No need for immediate reporting.

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