NORCET -4 , 2023
Child Health Nursing (Pediatrics)
Medium
All of the following symptoms would be seen in a client with respiratory distress syndrome (RDS), EXCEPT?
Appeared in: NORCET -4 , 2023
Explanation
- While subcostal retraction is a sign of increased work of breathing, it is not a primary criterion used in the classic scoring systems for Respiratory Distress Syndrome (RDS).
- The Silverman-Anderson score, a standard tool for grading the severity of RDS, specifically assesses intercostal and xiphoid retractions, but not subcostal retractions.
- In the context of an 'EXCEPT' question, subcostal retraction is the least specific or defining sign for RDS compared to the other hallmark symptoms listed.
Why Other Options Were Wrong
- Option A: Nasal flaring is a classic sign of RDS. It represents the infant's effort to reduce airway resistance during inspiration.
- Option B: Tachypnea (a respiratory rate greater than 60/min) is a cardinal sign of RDS and one of the earliest compensatory mechanisms for hypoxia.
- Option D: Expiratory grunting is a hallmark sign of RDS. It is the infant's physiological attempt to create auto-PEEP to prevent alveolar collapse.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Clinical signs of Neonatal Respiratory Distress Syndrome (RDS) to guide bedside assessment, documentation, and the next nursing action.
- Accurate assessment of a neonate's respiratory status is a critical nursing skill. Recognizing the specific signs of RDS, such as grunting, flaring, and retractions, allows for early intervention.
- Using a standardized tool like the Silverman-Anderson score helps nurses to objectively quantify the severity of distress, communicate findings effectively, and track the infant's response to treatment (e.g., CPAP, surfactant).
- A score greater than 6 on the Downe score or a high Silverman-Anderson score suggests impending respiratory failure, requiring immediate escalation of care, including potential intubation and mechanical ventilation.
How to Approach the Question
- First, identify that this is a negative question because of the word 'EXCEPT'. This means you are looking for the option that does not fit with the others.
- Recall the cardinal signs and symptoms of Respiratory Distress Syndrome (RDS) in a neonate.
- Evaluate each option: Nasal flaring, tachypnea, and grunting are all well-known, classic signs of RDS.
- Consider the option 'Subcostal retraction'. While it is a sign of respiratory distress, think about its specificity to RDS compared to the other options.
- Recall or deduce that specific scoring systems for RDS, like the Silverman-Anderson score, focus on intercostal and xiphoid retractions, not subcostal. This makes 'Subcostal retraction' the outlier and the correct answer for an 'EXCEPT' question.
Concept Tested & Keywords
- Concept Tested: Clinical signs of Neonatal Respiratory Distress Syndrome (RDS)
- Stem keywords: respiratory distress syndrome (RDS), symptoms, client
- Lead-in keywords: EXCEPT
- Negative lead-in flag: Question asks for the symptom NOT typically considered a hallmark sign of RDS.
Question ID
QfGwiAAct2tNfCr9sdynIs
Reference Book
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 155-157
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1086-1088
Practise the full NORCET -4 , 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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