Which signs identify acute pulmonary edema on a nursing unit and what is a typical initial management?

• A. Sudden dyspnea, orthopnea, bibasilar crackles, and anxiety; position upright, provide supplemental oxygen, administer diuretics as ordered, and monitor vitals and fluid status with BNP testing as indicated.
• B. Chest pain with diaphoresis; administer nitroglycerin and obtain ECG.
• C. Gradual onset cough with green sputum; place in Trendelenburg and administer bronchodilators only.
• D. Fever with productive cough; start antibiotics and place patient supine.

Answer: (A)

Acute pulmonary edema shows up with abrupt shortness of breath that worsens when lying down (orthopnea), along with lung crackles at the bases and a sense of anxiety or impending doom. The body is trying to cope with fluid buildup in the lungs, so early recognition focuses on how the patient breathes, sounds, and feels.

The best initial management on a nursing unit centers on improving oxygenation and reducing the fluid backing into the lungs. Position the patient upright or in a high Fowler’s/semi‑upright position to ease breathing and decrease venous return to the heart. Administer supplemental oxygen to keep saturation in the target range. Diuretics are given as ordered to mobilize excess fluid; ensure they are given per protocol and monitor the patient for diuretic response and any electrolyte changes. Closely monitor vital signs, respiratory status, urine output, and fluid balance to assess response to treatment and detect deterioration early. BNP testing can help confirm a cardiac cause if available, but it does not substitute for rapid clinical management.

Choices describing chest pain with diaphoresis, a gradual cough with green sputum requiring bronchodilators, or fever with productive cough point to other conditions (cardiac ischemia, COPD/asthma, or infection) and do not reflect the typical acute pulmonary edema presentation or initial management.