A patient in the emergency department has dyspnea, asymmetrical chest expansion, and an oxygen saturation of 90%. A chest X-ray shows a collapsed lung and blood accumulation in the pleural space.
What is the correct diagnosis?
Flail chest.
Tension pneumothorax.
Simple pneumothorax.
Hemothorax.
The Correct Answer is D
Choice A rationale
Flail chest is the paradoxical movement of a section of the chest wall, caused by multiple rib fractures in two or more places. It is characterized by paradoxical chest wall motion, where the injured segment moves in during inspiration and out during expiration. While it is a severe chest injury, it does not typically involve a large accumulation of blood in the pleural space, which is the defining characteristic mentioned in the patient's presentation.
Choice B rationale
A tension pneumothorax is a life-threatening condition where air enters the pleural space but cannot exit, causing a rapid increase in intrathoracic pressure. This leads to tracheal deviation, hypotension, and profound respiratory distress. While it can cause a collapsed lung and dyspnea, the defining characteristic is air trapping, not blood accumulation in the pleural space, making this diagnosis inconsistent with the patient's specific presentation of hemothorax.
Choice C rationale
A simple pneumothorax is the presence of air in the pleural space, causing the lung to collapse, but without the one-way valve effect seen in a tension pneumothorax. It presents with dyspnea and asymmetrical chest expansion. While it causes a collapsed lung, the defining feature of this patient's case is the presence of a blood accumulation in the pleural space, which is not a hallmark of a simple pneumothorax.
Choice D rationale
A hemothorax is a medical condition characterized by the accumulation of blood in the pleural cavity, which is the space between the lungs and the chest wall. The presence of a collapsed lung, blood accumulation in the pleural space, dyspnea, and asymmetrical chest expansion directly corresponds to the classic presentation of a hemothorax. This diagnosis accurately and completely accounts for all the symptoms described in the patient's clinical scenario. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Paradoxical chest movement is the hallmark sign of flail chest. This occurs when two or more adjacent ribs are fractured in two or more places, creating a free-floating segment of the chest wall. During inspiration, the negative intrathoracic pressure causes the unstable segment to be pulled inward, while the rest of the chest expands. During expiration, the segment bulges outward, opposite the normal movement of the chest wall.
Choice B rationale
Flail chest involves significant trauma to the chest wall, including multiple rib fractures. This causes severe pleuritic pain, which is exacerbated by the movement of the chest wall during inspiration. The fractured ribs and associated soft tissue injury irritate the parietal pleura, leading to a sharp, stabbing pain that the patient describes as being worse with deep breaths.
Choice C rationale
Bradycardia is not a typical finding in flail chest. The patient's pain, respiratory distress, and potential hypoxemia trigger a sympathetic nervous system response. This compensatory mechanism leads to an increase in heart rate to maintain cardiac output and oxygen delivery to the tissues. Therefore, tachycardia is a more expected finding in a patient with flail chest. Normal heart rate is 60 to 100 beats per minute.
Choice D rationale
Jaundice, characterized by yellowing of the skin and eyes, is a result of hyperbilirubinemia, a condition associated with liver dysfunction, biliary obstruction, or excessive red blood cell destruction. It is not a direct finding or complication of flail chest, which is a musculoskeletal and respiratory injury. Jaundice would be a coincidental finding and not a direct sign.
Choice E rationale
Chest pain is a prominent and expected finding in a patient with flail chest. The pain is a direct result of the trauma, including multiple rib fractures and the associated soft tissue and muscle injury. The severity of the pain is often directly related to the number and location of the fractures and is a major contributor to the patient's respiratory distress. .
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
Acknowledging the frightening nature of the illness is a crucial therapeutic communication technique. By validating the patient's feelings of fear and anxiety, the nurse establishes trust and rapport. This approach shows empathy and helps the patient feel understood, which can reduce psychological distress. It also provides a foundation for the patient to be more receptive to subsequent nursing interventions and education.
Choice B rationale
Providing simple, clear explanations of what is happening helps to demystify the situation and reduce the patient's anxiety. When a person is anxious, their cognitive processing can be impaired, making it difficult to comprehend complex information. Short, concise explanations about the cause of their symptoms and the purpose of interventions can help the patient feel more in control and less overwhelmed, thereby alleviating some of their fear.
Choice C rationale
Requesting a prescription for antianxiety medications is not the most appropriate immediate action. While medications may eventually be necessary, the initial nursing actions should focus on non-pharmacological interventions. These include therapeutic communication and supportive presence. Pharmacological interventions are typically reserved for situations where non-pharmacological methods are insufficient or the anxiety is severe enough to cause physiological instability.
Choice D rationale
Staying with the patient and speaking in a quiet, calm voice is a primary nursing action for an anxious patient. A calm, reassuring presence can help to de-escalate the patient's anxiety by providing a sense of security and support. The nurse's calm demeanor can also model appropriate emotional regulation for the patient, which can help to reduce their physiological and psychological distress. This action is simple, immediate, and highly effective.
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