An ICU patient with acute stroke is undergoing airway suctioning. During the procedure, the patient suddenly develops expiratory wheeze and increased work of breathing. Which immediate complication is most likely?

1. A

   Pneumothorax

2. B

   Laryngospasm

3. C

   Atelectasis

4. D

   Bronchospasm and laryngospasm

Appeared in: NORCET 9 Mains - 2025

Explanation

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• The patient's key symptom is expiratory wheeze, a high-pitched whistling sound during exhalation.
• This sound is the hallmark sign of bronchospasm, which is the sudden constriction of the smooth muscles in the lower airways (bronchi).
• Airway suctioning is a common trigger for bronchospasm due to mechanical irritation of the tracheal and bronchial mucosa.
• While laryngospasm (upper airway spasm) is also a risk, the presence of expiratory wheeze makes bronchospasm the certain component of the correct diagnosis.

Why Other Options Were Wrong

• Option A: Pneumothorax (collapsed lung) does not cause wheezing. Its classic sign is absent or severely diminished breath sounds on the affected side.
• Option B: The hallmark sign of laryngospasm is inspiratory stridor (a high-pitched sound on inhalation) due to upper airway obstruction, not expiratory wheeze from the lower airways.
• Option C: Atelectasis (alveolar collapse) results in diminished breath sounds or fine crackles over the affected area. It does not produce the active, musical sound of wheezing.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Complications of Airway Suctioning in acute care settings.
• Immediate recognition of bronchospasm during suctioning is a critical nursing skill. The nurse must stop the procedure, administer 100% oxygen, and prepare to give a fast-acting bronchodilator (like albuterol) as ordered.
• This scenario underscores the importance of using proper suctioning technique, including hyperoxygenation, limiting pass duration to less than 15 seconds, and using the lowest effective pressure to minimize airway irritation.
• What if? If the patient had developed a high-pitched sound on inspiration (stridor) instead of expiration, the most likely complication would be laryngospasm. The immediate nursing priority would be to provide positive pressure ventilation with a bag-valve-mask to try and break the spasm and call for immediate assistance, as it can lead to complete airway obstruction.

How to Approach the Question

• First, identify the core components of the clinical scenario: a patient undergoing airway suctioning.
• Next, isolate the key clinical sign that develops: 'expiratory wheeze'. This is the most important clue.
• Evaluate each option by considering its underlying pathophysiology and classic signs.
• Differentiate between upper and lower airway sounds. Expiratory wheeze is a lower airway sound. Inspiratory stridor is an upper airway sound.
• Match the key sign (expiratory wheeze) to the complication. Bronchospasm is the constriction of the lower airways (bronchi) and directly causes expiratory wheezing.
• Eliminate other options based on their typical presentations: Pneumothorax (absent sounds), Laryngospasm (inspiratory stridor), and Atelectasis (diminished sounds/crackles).

Concept Tested & Keywords

• Concept Tested: Complications of Airway Suctioning
• Stem keywords: airway suctioning, expiratory wheeze, increased work of breathing, acute stroke
• Lead-in keywords: immediate complication, most likely
• Clinical cues: The key sign is 'expiratory wheeze', which points to a lower airway problem.

Question ID

QajSuTTXwlcfxDKLKj6JCk

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Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 716-718

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 199-201