Progressive Care Nursing Certification (PCCN) Practice Exam

After a major abdominal surgery, a patient develops rales bilaterally and increased oxygen requirements. This could indicate:

1. Pneumonia

2. Acute respiratory distress syndrome

3. Cardiac failure

4. Asthma attack

The correct answer is: Acute respiratory distress syndrome

The development of bilateral rales and increased oxygen requirements following major abdominal surgery can indeed indicate acute respiratory distress syndrome (ARDS). This condition often arises in the context of a major surgical procedure due to several factors, including fluid overload, atelectasis, or direct lung injury from aspiration or other complications that can emerge during or after surgery. In ARDS, the alveoli become inflamed and filled with fluid, leading to decreased lung compliance and impaired gas exchange, which aligns with the patient's need for increased oxygen. The presence of rales suggests fluid accumulation in the lungs, which is characteristic of this syndrome. While pneumonia, cardiac failure, and asthma could also lead to respiratory distress, they do not typically follow a major surgical procedure as distinctly as ARDS does. Pneumonia would require additional clinical signs or symptoms, cardiac failure would present differently with more systemic symptoms, and an asthma attack is less likely to develop acutely in a postoperative context without prior history or triggers. Thus, the clinical scenario aligns best with acute respiratory distress syndrome.