Examkin

Question

Difficulty: MediumPhysiological Adaptation

A nurse is evaluating a client who is receiving aggressive intravenous fluid resuscitation for severe dehydration. The client suddenly reports severe orthopnea and a feeling of impending doom. Which of the following clinical assessment findings indicate the development of acute pulmonary edema? (Select all that apply.)

  1. Bilateral fine crackles progressing from the lung bases upwardAnswer
  2. B
    A narrowing pulse pressure with a weak, thready peripheral pulse
  3. Production of pink, frothy sputum upon coughingAnswer
  4. D
    Arterial blood gas (ABG) revealing uncompensated metabolic alkalosis
  5. Auscultation of a prominent S3 gallop rhythm at the cardiac apexAnswer

Answer

The correct findings that indicate acute pulmonary edema are bilateral fine crackles progressing upward, the production of pink, frothy sputum, and the presence of an S3 gallop rhythm.
Acute pulmonary edema occurs when excessive hydrostatic pressure in the pulmonary vasculature forces fluid across the alveolar-capillary membrane into the air spaces. This alveolar flooding manifests as bilateral crackles that progress upward and the production of pink, frothy sputum from ruptured capillaries. Furthermore, the excess fluid volume increases cardiac preload, stretching the left ventricle and producing a classic S3 gallop rhythm during ventricular filling.

Step-by-Step Solution

1
Analyze the clinical scenario and the client's current interventions.
The client is receiving aggressive intravenous fluid resuscitation and is now exhibiting sudden, severe respiratory distress and anxiety.
Rapid fluid volume expansion significantly increases the risk of left ventricular volume overload, forcing fluid backward into the pulmonary circuit.
2
Identify respiratory manifestations of alveolar flooding.
Crackles starting at the lung bases and pink, frothy sputum are identified as confirming signs.
Increased pulmonary capillary hydrostatic pressure pushes fluid and red blood cells into the alveoli, causing adventitious lung sounds and blood-tinged, aerated secretions.
3
Identify cardiac manifestations associated with acute fluid volume overload.
An S3 gallop rhythm is recognized as an expected finding.
The S3 sound is generated by the rapid rush of blood into an already distended left ventricle during early diastole.
4
Differentiate pulmonary edema from other pathophysiological shock and acid-base states.
Narrowing pulse pressure and metabolic alkalosis are excluded as correct choices.
A narrowing pulse pressure indicates low stroke volume (shock), while pulmonary edema classically causes respiratory acidosis due to impaired gas exchange, not metabolic alkalosis.

Key Concept

Acute Pulmonary Edema Assessment and Recognition
Rate this question

Topics

Physiological Adaptation

More questions from this topic