A nurse is caring for a client who has a central venous catheter and suddenly develops chest pain, dyspnea, dizziness, and tachycardia. The nurse suspects air embolism and clamps the catheter immediately. What other action should the nurse take at this time?
Remove the catheter.
Replace the infusion system.
Prepare for chest tube insertion.
Place the client on his left side in Trendelenburg position.
The Correct Answer is D
A. Remove the catheter: Removing the catheter may not be the immediate priority. The nurse should focus on preventing further air entry into the circulation and addressing the symptoms.
B. Replace the infusion system: While ensuring that the infusion system is intact is important, it is not the primary action needed to manage an air embolism.
C. Prepare for chest tube insertion: Chest tube insertion is not the primary intervention for an air embolism. The focus should be on preventing the progression of the embolism and providing supportive care.
D. Place the client on his left side in Trendelenburg position: This is the correct answer. Placing the client on the left side in Trendelenburg position is a maneuver used to trap air in the right atrium, preventing it from traveling to the pulmonary artery. The left side position helps to prevent the air from traveling to the right ventricle and into the pulmonary artery, reducing the risk of further complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Cheyne-Stokes respirations: Cheyne-Stokes respirations are characterized by alternating periods of hyperventilation followed by apnea. This respiratory pattern is often observed in clients with conditions affecting the central nervous system, such as brain injury or stroke.
B. Apneustic respirations: Apneustic respirations are characterized by prolonged, gasping inhalations followed by extremely short, ineffective exhalations. This pattern is associated with damage to the pons, a part of the brainstem.
C. Stridor: Stridor is a high-pitched, noisy breathing sound caused by turbulent airflow through a partially obstructed airway. It is not related to the described alternating pattern of hyperventilation and apnea.
D. Kussmaul respirations: Kussmaul respirations are deep, rapid respirations often seen in metabolic acidosis. They are not characterized by the alternating pattern described in the scenario.
Correct Answer is A
Explanation
A. Smoking cessation: Chronic bronchitis is often associated with smoking and exposure to tobacco smoke. The most effective preventive measure for chronic bronchitis is to quit smoking and avoid exposure to secondhand smoke. Smoking cessation not only prevents chronic bronchitis but also improves overall respiratory health.
B. Regular moderate exercise: While regular exercise is beneficial for overall health, it is not specifically cited as a primary preventive measure for chronic bronchitis. However, exercise can contribute to overall respiratory health and well-being.
C. Maintenance of ideal weight: Maintaining an ideal weight is important for overall health, but it is not identified as a specific preventive measure for chronic bronchitis.
D. Annual influenza immunization: Influenza immunization is important for preventing influenza (flu) and its complications. While individuals with chronic bronchitis may be at increased risk for respiratory infections, annual influenza immunization is not a direct preventive measure for chronic bronchitis itself.
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