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.

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Myringotomy: Myringotomy is a procedure involving the insertion of tubes into the eardrum to treat conditions such as chronic ear infections. This procedure is not associated with a significant risk of deep-vein thrombosis.

B. Hip arthroplasty: Hip arthroplasty, or hip replacement surgery, is associated with an increased risk of deep-vein thrombosis due to factors such as immobility, surgical trauma, and alterations in blood flow. Prophylactic measures, such as anticoagulant medications and early ambulation, are often employed to reduce this risk.

C. Cataract extraction: Cataract extraction is a procedure to remove a cloudy lens from the eye. This surgery is not typically associated with a high risk of deep-vein thrombosis.

D. Laparoscopic appendectomy: Laparoscopic appendectomy, a minimally invasive procedure to remove the appendix, is generally associated with a lower risk of deep-vein thrombosis compared to major orthopedic surgeries like hip arthroplasty.

A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis

Correct Answer is B

Explanation

A. Respiratory alkalosis: Respiratory alkalosis is characterized by a decrease in carbonic acid (CO2) due to hyperventilation, leading to an increased pH. Shallow respirations would not typically cause respiratory alkalosis.

B. Respiratory acidosis: This is the correct answer. Shallow respirations result in inadequate elimination of CO2, leading to an excess of carbonic acid and the development of respiratory acidosis.

C. Metabolic acidosis: Metabolic acidosis is characterized by a decrease in bicarbonate (HCO3-), not carbonic acid (CO2). Shallow respirations would not directly contribute to metabolic acidosis.

D. Metabolic alkalosis: Metabolic alkalosis is characterized by an increase in bicarbonate (HCO3-). Shallow respirations would not typically cause metabolic alkalosis.

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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?

Nursing Test Bank

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Correct Answer is B

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