What assessment finding would alert the nurse that a preterm infant is developing respiratory distress syndrome?

Choice A rationale Expiratory grunting is a common and significant sign of respiratory distress syndrome (RDS) in preterm infants. The grunt is a compensatory mechanism caused by the partial closure of the glottis during expiration, which helps to increase end-expiratory pressure and prevent alveolar collapse, effectively acting as an attempt to establish continuous positive airway pressure (CPAP). Choice B rationale Expiratory wheezing is typically associated with lower airway obstruction, such as bronchospasm or inflammation, as seen in conditions like asthma or bronchiolitis, rather than the primary pathology of surfactant deficiency and alveolar collapse characteristic of neonatal respiratory distress syndrome (RDS). Wheezing is a less common finding in classic RDS. Choice C rationale Inspiratory rhonchi are coarse, low-pitched sounds indicating secretions in the larger airways, often associated with infectious processes like pneumonia or mucus plugging. Although a preterm infant can develop pneumonia, rhonchi are not the hallmark finding that specifically alerts the nurse to the development of primary respiratory distress syndrome (RDS). Choice D rationale Inspiratory stridor is a high-pitched sound indicating obstruction in the upper airway, typically in the larynx or trachea, seen in conditions such as laryngomalacia or croup. This finding is unrelated to the primary issue in RDS, which is the lack of pulmonary surfactant leading to atelectasis and decreased functional residual capacity in the lower airways.