Progressive Care Nursing Certification (PCCN) Practice Exam

The presence of bilateral diffuse infiltrates is most commonly associated with which respiratory condition in a post-near drowning patient?

1. Asthma exacerbation

2. Chronic obstructive pulmonary disease

3. Acute respiratory distress syndrome

4. Pneumothorax

The correct answer is: Acute respiratory distress syndrome

Bilateral diffuse infiltrates in a post-near drowning patient are most commonly associated with acute respiratory distress syndrome (ARDS). In cases of near drowning, whether in fresh or saltwater, aspirated water can lead to significant lung injury due to the influx of fluid into the alveoli, which subsequently disrupts normal gas exchange. This condition can result in pulmonary edema and inflammation, hallmarks of ARDS, leading to the characteristic bilateral infiltrates observed on a chest X-ray. The development of ARDS is influenced by various factors related to lung injury, and in the context of drowning, the initial inflammatory response and fluid overload in the lungs are critical. This pathophysiology explains the presence of diffuse infiltrates, indicating a more severe and widespread respiratory issue rather than localized conditions like those seen in asthma exacerbation or a pneumothorax. On the other hand, chronic obstructive pulmonary disease typically presents with different radiographic findings and is not directly associated with the acute onset following drowning incidents. Thus, acute respiratory distress syndrome is the most accurate choice reflecting the clinical scenario described.