RN Nursing · Pneumonia · Practice question
A patient with bacterial pneumonia begins coughing up pink frothy sputum and develops worsening crackles and dyspnea. Which complication should the nurse suspect?
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Atelectasis
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ARDS (acute respiratory distress syndrome)
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Pleural effusion
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✓
Pulmonary edema
Answer & explanation
Correct: Pulmonary edema
Pink frothy sputum is a classic hallmark of pulmonary edema, arising when fluid leaks from pulmonary capillaries into the alveoli and mixes with air and surfactant, producing a pink, frothy appearance. Worsening crackles (particularly fine crackles at the lung bases) and acute dyspnea accompany this finding, confirming fluid accumulation in the alveolar spaces. In a patient with bacterial pneumonia, pulmonary edema can develop as a complication because the inflammatory process damages the alveolar-capillary membrane, increases pulmonary capillary pressure, or triggers cardiogenic dysfunction. Atelectasis involves collapse of alveoli and typically presents with decreased breath sounds and dullness on percussion rather than pink frothy sputum. ARDS is a possible consideration because it also involves alveolar flooding, but its sputum is usually not described as pink and frothy; ARDS presents more with refractory hypoxemia and diffuse infiltrates. Pleural effusion involves fluid in the pleural space, not alveoli, and would cause diminished breath sounds and dullness but not the characteristic frothy sputum. Therefore, the combination of pink frothy sputum, crackles, and dyspnea most specifically points to pulmonary edema as the primary complication to suspect in this clinical scenario.
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