A client suffered a fractured femur and is scheduled for surgery one day after sustaining the injury. The client develops acute respiratory distress syndrome (ARDS) and the healthcare provider suspects fat embolism (FES) based on which of the following clinical manifestations? (Select all that apply.)

Decreased PaO2 <60mmHg.

PaO2 greater than 80mmHg.

Decreased platelet count and hematocrit levels.

Changes in ST segment and T-wave.

PaCO2 40mmHg.

Answer and Explanation

Correct Answer : A,C,D

A. Decreased PaO2 <60mmHg: A hallmark of fat embolism syndrome (FES) is hypoxemia, which results in a PaO2 less than 60 mmHg. This is a key indicator of the severity of respiratory compromise in FES and ARDS.

B. PaO2 greater than 80mmHg: This would not be consistent with FES. Fat embolism often causes significant hypoxemia, and PaO2 greater than 80 mmHg would indicate adequate oxygenation.

C. Decreased platelet count and hematocrit levels: In fat embolism syndrome, there is often a decrease in platelet count and hematocrit due to disseminated intravascular coagulation (DIC), which can occur as a complication of fat embolism.

D. Changes in ST segment and T-wave: Electrocardiographic changes, including changes in ST segment and T-wave, are commonly seen in fat embolism syndrome due to myocardial injury, hypoxemia, or shock.

E. PaCO2 40mmHg: A PaCO2 of 40 mmHg is within normal limits and does not indicate any significant respiratory distress or abnormality that would be expected in fat embolism syndrome.

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Correct Answer is D

Explanation

A. Crepitus, or subcutaneous emphysema, near the insertion site can occur due to air leaking into the subcutaneous tissue. While it should be monitored, it does not always require immediate provider notification unless it is extensive or worsening.

B. The absence of visible eyelets indicates the chest tube is properly positioned within the pleural space. This is an expected finding and does not require provider notification.

C. Bubbling of the water in the water seal chamber with exhalation is normal in a client with a pneumothorax. It indicates air is being evacuated from the pleural space.

D. Movement of the trachea toward the unaffected side is a sign of tension pneumothorax, a life-threatening complication. This finding requires immediate notification of the provider and emergency intervention to relieve the pressure in the pleural space.

A. A condition in which the ribs are fractured in multiple places, resulting in a segment of the chest wall that moves independently during respiration B. A condition in which the chest wall is paralyzed, resulting in difficulty breathing C. A condition in which the lungs are unable to fully expand, resulting in decreased oxygenation D. A condition in which the diaphragm becomes weak, resulting in decreased lung expansion

Correct Answer is A

Explanation

A. Flail chest occurs when multiple ribs are fractured in more than one location, creating a free-floating segment of the chest wall. This segment moves paradoxically during respiration, meaning it moves inward during inspiration and outward during expiration, which impairs effective breathing and oxygenation.

B. Paralysis of the chest wall may occur in conditions like spinal cord injuries but is not the defining characteristic of flail chest.

C. While decreased oxygenation can occur with flail chest due to impaired ventilation, the defining feature is the paradoxical movement of the fractured rib segment.

D. Weakness of the diaphragm can impair lung expansion, but this is characteristic of conditions like diaphragmatic paralysis, not flail chest.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

Correct Answer is D

Explanation

A patient is admitted to the respiratory unit with flail chest. The nurse understands that a flail chest is:

Correct Answer is A

Explanation

A nurse is caring for a client who has asthma and is taking Beclomethasone. The nurse should monitor the client for which of the following adverse effects?

A patient with chronic obstructive pulmonary disease (COPD) presents with dyspnea and wheezing. What is the most appropriate initial nursing intervention to manage these symptoms?

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Which assessment data would warrant immediate intervention by the nurse?

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