The nurse is caring for four clients. Which client does the nurse identify at greatest risk of developing acute respiratory distress syndrome (ARDS)?

24-year-old male admitted with blunt chest trauma and aspiration

39-year-old male with a history of alcohol abuse and chronic pancreatitis

70-year-old male post heart valve surgery receiving 1 unit of packed red blood cells

55-year-old female with severe sepsis from a urinary tract infection

Answer and Explanation

The Correct Answer is A

A. Blunt chest trauma and aspiration are direct lung injuries, which place the client at the highest risk for ARDS. Trauma damages the alveolar-capillary membrane, and aspiration of gastric contents triggers intense pulmonary inflammation, pulmonary edema, and impaired oxygen exchange. Direct lung insults are the most potent predictors of ARDS development.

B. Alcohol abuse and chronic pancreatitis are indirect risk factors. Severe pancreatitis may lead to systemic inflammatory response syndrome (SIRS) and secondary ARDS, but the risk is lower compared with direct pulmonary injury.

C. Postoperative heart valve surgery with a single unit transfusion has a low immediate risk of ARDS. While TRALI (transfusion-related acute lung injury) can occur, it is rare with only one unit, and surgical stress alone does not carry as high a risk as trauma with aspiration.

D. Severe sepsis is an indirect cause of ARDS, as systemic inflammation can lead to capillary leak in the lungs, but it is generally less immediately high-risk than direct pulmonary injury. Close monitoring is required, but trauma with aspiration remains the greatest risk scenario.

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Correct Answer is B

Explanation

A. Dextrose 5% in water (D5W) is a hypotonic solution once dextrose is metabolized. It primarily provides free water for cellular hydrationbut does not expand intravascular volume effectively, making it inappropriate for acute blood loss.

B. Lactated Ringer’s (LR) is an isotonic crystalloidthat closely resembles plasma electrolyte composition. It is ideal for rapid intravascular volume replacementin clients with acute hemorrhage, helping to restore blood pressure and perfusion until blood products can be administered.

C. This solution is hypotonic (0.45% NaCl)and will shift into cells rather than remain in the vascular space. It is not suitable for initial resuscitation of a hemorrhaging client, as it does not adequately expand circulating volume.

D. There is no standard 33% saline solution used in clinical practice. Hypotonic saline solutions are not used for acute volume replacementin severe bleeding.

A. Tighten the straps on the nasal cannula B. Increase the oxygen flow rate to 8 L/min C. Check the tubing for kinks, leaks, or obstructions D. Check to determine whether the oxygen delivery system is adequately humidified

Correct Answer is C

Explanation

A. While properly securing the cannula is important for comfort and consistent oxygen delivery, it is unlikely to be the primary cause of a significant drop in SpO2unless the cannula is completely dislodged.

B. Immediately increasing the flow rate without assessing the equipment or patient may be premature. The drop in SpO2 could be caused by mechanical issues or patient factorsthat need to be addressed first. Additionally, flow rates above 6 L/min are generally not recommended for standard nasal cannulabecause they can cause mucosal dryness and discomfort.

C. The first action is to ensure the oxygen delivery system is functioning properly, as tubing obstruction, disconnection, or leaks are common, reversible causes of hypoxemia. Correcting these issues can immediately improve oxygenationbefore escalating care or altering prescriptions.

D. Humidification improves comfort and prevents mucosal dryness, but it does not immediately affect oxygen saturation. Ensuring proper tubing function takes priority.

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The nurse is caring for four clients. Which client does the nurse identify at greatest risk of developing acute respiratory distress syndrome (ARDS)?

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