A nurse is planning care for a client who has a wound infection with methicillin-resistant Staphylococcus aureus. Which of the following infection control precautions should the nurse initiate for the client?

A. Crackles on auscultation: Crackles are indicative of fluid in the alveoli, commonly seen in conditions like pneumonia, pulmonary edema, or atelectasis. They are not a hallmark of tension pneumothorax, which primarily involves air accumulation in the pleural space causing lung collapse and mediastinal shift rather than alveolar fluid accumulation.

B. Tracheal deviation: Tracheal deviation away from the affected side is a classic sign of tension pneumothorax. As air accumulates under pressure in the pleural space, it shifts the mediastinum, compresses the opposite lung, and can impede venous return, leading to life-threatening respiratory and hemodynamic compromise. Immediate decompression is required.

C. Hypertension: Tension pneumothorax typically causes hypotension rather than hypertension. The increasing intrathoracic pressure impairs venous return to the heart, reducing cardiac output and leading to shock. Hypertension is not expected.

D. Hemoptysis: Hemoptysis, or coughing up blood, is associated with lung parenchymal injury, infections, or pulmonary embolism. It is not a primary feature of tension pneumothorax, which involves air accumulation and mediastinal shift rather than bleeding into the airway.

A. A client who is using accessory muscles to breathe: The use of accessory muscles indicates severe respiratory distress and increased work of breathing. This is a sign that the client may be experiencing impending respiratory failure, requiring immediate intervention to prevent hypoxia and potential respiratory collapse. Prompt assessment and treatment, including oxygen therapy and bronchodilator administration, are critical.

B. A client who has intermittent inspiratory and expiratory wheezes: Wheezing is a common finding in asthma and may indicate mild to moderate bronchoconstriction. While it requires monitoring and treatment, it does not necessarily indicate immediate danger unless accompanied by other signs of severe distress.

C. A client who has an oxygen saturation of 94%: An oxygen saturation of 94% is slightly below normal but generally not an emergency in an otherwise stable client. It warrants monitoring and supplemental oxygen if it declines, but it does not require immediate intervention compared with signs of severe respiratory compromise.

D. A client who has a daytime cough: A daytime cough can be a symptom of asthma or poor control but is not an indicator of acute respiratory distress. This finding is important for long-term management but does not necessitate urgent intervention.