A nurse is collecting data for a client who has tension pneumothorax. Which of the following findings should the nurse expect following tracheal deviation?
Respiratory alkalosis
Increased venous return
Decreased cardiac output
Dilated ventricles
The Correct Answer is C
A. Respiratory alkalosis: Respiratory alkalosis is generally associated with hyperventilation and is not directly caused by tension pneumothorax. In tension pneumothorax, the primary issues are related to pressure changes within the thoracic cavity, not respiratory alkalosis.
B. Increased venous return: In tension pneumothorax, venous return is actually decreased due to the increased intrathoracic pressure compressing the great vessels, which impedes blood flow back to the heart.
C. Decreased cardiac output: Tension pneumothorax causes a significant increase in intrathoracic pressure, leading to compression of the heart and great vessels, which results in decreased venous return and ultimately decreased cardiac output. This is a critical and life-threatening consequence of tension pneumothorax.
D. Dilated ventricles: Dilated ventricles are more commonly seen in chronic heart conditions such as heart failure, rather than in acute tension pneumothorax. Tension pneumothorax typically results in reduced ventricular filling rather than dilation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. The client is producing large amounts of clear, watery nasal discharge and experiencing postnasal drip: Clear, watery nasal discharge is more indicative of allergic rhinitis rather than sinusitis, which typically presents with thicker, purulent discharge.
B. The client has a history of both tension and vascular headaches and takes prescription migraine medication as needed: While headaches can accompany sinusitis, this option does not directly address symptoms specific to sinusitis, such as nasal congestion or facial pressure.
C. The client has nasal congestion that does not significantly improve with over-the-counter decongestants or antihistamines: Persistent nasal congestion despite the use of decongestants or antihistamines is a common symptom of sinusitis, indicating that the source of the problem may be inflammation or infection in the sinuses.
D.The client regularly uses saline-based nasal washes and a humidifier to clean and moisturize their sinuses: Regular use of these measures suggests the client is taking preventive care of their sinuses but does not necessarily indicate sinusitis.
Correct Answer is D
Explanation
A. Oral antibiotics: Antibiotics are not indicated for allergic rhinitis, as it is an allergic condition rather than an infection.
B. Oral decongestants: While decongestants can provide temporary relief from nasal congestion, they can also cause rebound congestion if used for prolonged periods.
C. Nasal saline irrigation: Nasal saline irrigation can help to clear out mucus and allergens but is not a primary treatment for allergic rhinitis.
D. Intranasal corticosteroids: Intranasal corticosteroids are the most effective treatment for allergic rhinitis, as they reduce inflammation in the nasal passages and help to alleviate symptoms.
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