A patient has a pulmonary embolism and is started on oxygen.
The student nurse asks, "What are the risk factors for a pulmonary embolism?" Which of the following is not a correct answer?

Choice A rationale

If the endotracheal tube were in the esophagus, there would be no chest wall expansion on either side, and breath sounds would be absent. Instead, abdominal distention would be observed as air enters the stomach. The absence of chest wall expansion on only one side indicates a problem within the respiratory tract, not an esophageal intubation.

Choice B rationale

The right main bronchus is wider, shorter, and more vertical than the left, making it more likely for an endotracheal tube to be advanced too far and enter this bronchus. When the tube is lodged in the right main bronchus, the left lung is not ventilated, leading to the absence of breath sounds and chest wall expansion on the left side, as observed.

Choice C rationale

Vocal cord infection would cause symptoms such as hoarseness, pain, and potentially swelling. It does not typically lead to the absence of unilateral chest wall expansion. The absence of left-sided chest wall expansion is a mechanical ventilation issue related to the tube's position, not an infectious process of the larynx.

Choice D rationale

A blockage of the endotracheal tube by the patient's tongue is anatomically impossible. The endotracheal tube is designed to bypass the oral cavity and extend past the tongue into the trachea. While the tube could become occluded by secretions or kinking, the tongue is not a source of obstruction for an properly placed endotracheal tube.

Choice A rationale

Tachypnea, or an increased respiratory rate, is a compensatory mechanism initiated by the body in response to decreased oxygen availability. A pneumothorax causes lung collapse, reducing the surface area for gas exchange. This leads to hypoxemia and hypercapnia, which stimulate chemoreceptors in the brainstem to increase the respiratory rate and depth, in an attempt to improve ventilation and oxygenation. The normal respiratory rate for an adult is 12 to 20 breaths per minute.

Choice B rationale

A pneumothorax causes a collapsed lung, leading to significant respiratory distress. Patients will instinctively increase the use of accessory muscles, such as the scalenes and sternocleidomastoid, to help lift the rib cage and expand the chest cavity to increase the negative intrathoracic pressure needed for inspiration. Decreased use of these muscles would suggest an improvement in the patient's respiratory status, which is not expected with a pneumothorax.

Choice C rationale

A pneumothorax, especially a tension pneumothorax, can lead to a state of hypoxemia and hypercapnia, which triggers the sympathetic nervous system. The sympathetic response increases heart rate to improve cardiac output and oxygen delivery to the tissues. Therefore, tachycardia, not bradycardia, is a more common finding. Normal heart rate is 60 to 100 beats per minute.

Choice D rationale

Tracheal deviation is a critical late sign of a tension pneumothorax, a life-threatening condition where air accumulates in the pleural space and shifts the mediastinum away from the affected side. This shift can compress the great vessels and the unaffected lung, causing severe hemodynamic compromise and respiratory failure. The deviation is a result of the high pressure pushing the trachea to the side opposite the injury.

Choice E rationale

Pleuritic pain is a sharp, stabbing chest pain that is often described as being worse with inspiration or coughing. It is a classic symptom of pneumothorax, resulting from the irritation of the parietal pleura by the air that has escaped into the pleural space. The parietal pleura contains nerve endings, and its inflammation or irritation leads to this specific type of pain.