A nurse is assessing a patient following a gunshot wound to the chest.
For which of the following findings should the nurse monitor to detect a pneumothorax?

Choice A rationale

Increasing the suction pressure would not address the underlying issue of an air leak and could potentially worsen the patient's condition by causing further lung collapse or trauma. Continuous bubbling in the water-seal chamber indicates a persistent air leak from the pleural space, tubing, or at the insertion site, which needs to be identified and resolved. Adjusting the suction without finding the source of the leak is an inappropriate intervention.

Choice B rationale

Clamping the chest tube is a dangerous intervention as it can lead to a tension pneumothorax, a life-threatening condition. Clamping prevents air and fluid from exiting the pleural space, causing pressure to build up and compress the lung, heart, and great vessels. This action should only be performed for very brief periods under specific, controlled circumstances, such as when changing the drainage system.

Choice C rationale

Continuous bubbling in the water-seal chamber is not a normal finding. Normal bubbling in this chamber should only occur intermittently with the patient's respirations, indicating the resolution of the pneumothorax. Continuous bubbling signifies an ongoing air leak, which requires investigation. The nurse must not document this as a normal finding but rather as an abnormal assessment that warrants immediate action.

Choice D rationale

Continuous bubbling in the water-seal chamber indicates a persistent air leak in the pleural space or the drainage system. The nurse must systematically check all connections from the insertion site to the drainage unit to identify and correct the source of the leak. The goal is to ensure the integrity of the closed system to prevent atmospheric air from entering the chest and to facilitate lung re-expansion.

Choice A rationale

The assertion that persons between 30 and 40 years old are at high risk is incorrect. Shingles is caused by the reactivation of the varicella-zoster virus (VZV), which lies dormant in nerve cells after a person has had chickenpox. The risk of reactivation increases significantly with age, particularly in adults over 50. The immune system's ability to suppress the virus wanes with age, making older adults more susceptible.

Choice B rationale

This statement is inaccurate because the zoster vaccine (Zostavax) is not recommended for all ages. The CDC recommends Zostavax for immunocompetent adults 50 years and older. The newer Shingrix vaccine is now the preferred vaccine for adults aged 50 years and older. It is not approved for use in individuals under 18 years of age and is not a universal recommendation for all ages.

Choice C rationale

This statement is correct because individuals with compromised immune systems, such as those with leukemia, are at significantly higher risk for developing shingles. Leukemia impairs the function of the immune system's T-cells, which are critical for controlling the dormant varicella-zoster virus. The weakened immune response allows the virus to reactivate, leading to a shingles outbreak.

Choice D rationale

The claim that it is only possible to have one episode of the disease is false. While it is less common, recurrent episodes of shingles can occur. The varicella-zoster virus can reactivate multiple times throughout a person's life, especially in individuals with chronic illness or those who are immunocompromised. The risk of recurrence is higher in people with weakened immune systems.