Medical Surgical ARDS & Acute Respiratory Failure #1


A client was brought into the emergency department for smoke inhalation following a house fire. The nurse will monitor for which signs of acute respiratory distress syndrome (ARDS)? Select all that apply.


  1. Low oxygen saturation with oxygen delivery at 80% FiO2.
    • Rationale:

      This answer is correct because ARDS is characterized by refractory hypoxemia. This is hypoxemia that does not improve even with high levels of oxygen administered.

  2. Blood-tinged mucus and blood gases showing respiratory alkalosis.
    • Rationale:

      This answer is not correct because blood-tinged mucus is not characteristic of ARDS. Pneumonia may result in blood-tinged mucus production. A client with ARDS will display respiratory acidosis as opposed to respiratory alkalosis.

  3. Tachypnea and use of accessory muscles.
    • Rationale:

      This answer is correct because tachypnea and use of accessory muscles are signs of hypoxemia. Refractory hypoxemia is the hallmark clinical manifestation of ARDS.

  4. Bluish nail beds and restlessness.
    • Rationale:

      This answer is correct because bluish discoloration of nail beds or cyanosis, and restlessness are signs of hypoxemia. Hypoxemia that does not improve with oxygen administration is the hallmark sign of ARDS.

  5. A productive cough with green sputum.
    • Rationale:

      This answer is not correct because green sputum is associated with a respiratory infection. ARDS is not an infection but rather a respiratory disorder involving the Type II surfactant producing cells within the lungs.


The focus of this question is determining clinical manifestations associated with ARDS. ARDS is characterized by refractory hypoxemia and usually leads to respiratory failure if not recognized and treated promptly.


Learning Outcomes

Acute respiratory distress syndrome (ARDS) is characterized by refractory hypoxemia, or hypoxemia that does not respond to high levels of oxygen. ARDS can lead to acute respiratory failure and death is not recognized and treated in a timely manner. Clinical manifestations of ARDS include tachypnea, dyspnea, discoloration of skin and nails, and hypoxemia.

Test Taking Tip

It is essential to understand the pathophysiology of ARDS and the hallmark manifestation of refractory hypoxemia in order to answer this question correctly.

Video Rationale