A nurse in the PACU is assessing a client who has an endotracheal tube (ET) tube in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

Blockage of the ET tube by the client's tongue

Infection of the vocal cords

Passage of the ET tube into the esophagus

Movement of the ET tube into the right main bronchus

Answer and Explanation

The Correct Answer is D

A. Blockage of the ET tube by the client's tongue: If the ET tube is blocked by the tongue, the nurse would expect difficulty breathing or noisy respirations, not asymmetric chest wall expansion. This issue would typically affect both sides of the chest, not just one side.

B. Infection of the vocal cords: Infection of the vocal cords can lead to hoarseness or difficulty with speech but would not cause asymmetric chest wall expansion. The physical sign of unequal chest expansion is more related to airway placement or obstruction.

C. Passage of the ET tube into the esophagus: If the ET tube were in the esophagus, it would obstruct airflow entirely, leading to no chest expansion on either side and no air exchange. The observed asymmetry suggests partial blockage or malposition of the ET tube.

D. Movement of the ET tube into the right main bronchus: If the ET tube has moved into the right main bronchus, it would primarily ventilate the right lung, leading to absent expansion on the left side. This occurs because the tube is no longer in the trachea but in a more lateral position, ventilating only the right lung.

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Correct Answer is A

Explanation

A. Respiratory acidosis: Respiratory acidosis occurs when CO2 accumulates due to impaired ventilation, leading to a decrease in pH. The elevated PaCO2 (48 mm Hg) and low pH (7.32) confirm respiratory acidosis. Normal HCO3 (23 mEq/L) suggests no renal compensation at this point.

B. Respiratory alkalosis: Respiratory alkalosis is marked by a decrease in PaCO2, which is not seen here as the PaCO2 is elevated. A low pH further contradicts alkalosis, as it should be elevated. Therefore, respiratory alkalosis is not supported by these ABG values.

C. Metabolic acidosis: Metabolic acidosis shows a decrease in HCO3, which is normal in this case (23 mEq/L). Additionally, the elevated PaCO2 points to a respiratory origin of the acidosis, not a metabolic cause.

D. Metabolic alkalosis: Metabolic alkalosis involves elevated HCO3 and a higher pH, which is not observed here. The bicarbonate level is normal, and the pH is low, ruling out metabolic alkalosis. The primary issue in this case is respiratory acidosis, not metabolic.

A. Supraventricular Tachycardia (SVT) B. Sinus Bradycardia C. Sinus Tachycardia D. Normal Sinus Rhythm

Correct Answer is D

Explanation

A. Supraventricular Tachycardia (SVT): SVT is a rapid rhythm, typically 150-250 bpm, where P waves are often absent, abnormal, or hidden. The rate in this strip is 70 bpm, and clear P waves are present.

B. Sinus Bradycardia: Sinus bradycardia is characterized by a heart rate below 60 beats per minute. The heart rate in this strip is 70 bpm, which is not bradycardic.

C. Sinus Tachycardia: Sinus tachycardia is characterized by a heart rate greater than 100 beats per minute. The heart rate in this strip is 70 bpm, which is not tachycardic.

D. Normal Sinus Rhythm: The EKG strip demonstrates a regular rhythm with a heart rate between 60 and 100 beats per minute, and a normal P wave preceding every QRS complex, all consistent with the criteria for Normal Sinus Rhythm.

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A nurse in the PACU is assessing a client who has an endotracheal tube (ET) tube in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

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A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO2 48 mm Hg and the HCO3 is 23 mEq/L. The nurse should recognize that these findings indicate of which of the following acid-base balances?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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