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A patient is admitted to the respiratory unit with flail chest. The nurse understands that a flail chest is:

A condition in which the ribs are fractured in multiple places, resulting in a segment of the chest wall that moves independently during respiration

A condition in which the chest wall is paralyzed, resulting in difficulty breathing

A condition in which the lungs are unable to fully expand, resulting in decreased oxygenation

A condition in which the diaphragm becomes weak, resulting in decreased lung expansion

Answer and Explanation

The Correct Answer is A

A. Flail chest occurs when multiple ribs are fractured in more than one location, creating a free-floating segment of the chest wall. This segment moves paradoxically during respiration, meaning it moves inward during inspiration and outward during expiration, which impairs effective breathing and oxygenation.

B. Paralysis of the chest wall may occur in conditions like spinal cord injuries but is not the defining characteristic of flail chest.

C. While decreased oxygenation can occur with flail chest due to impaired ventilation, the defining feature is the paradoxical movement of the fractured rib segment.

D. Weakness of the diaphragm can impair lung expansion, but this is characteristic of conditions like diaphragmatic paralysis, not flail chest.

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Correct Answer is C

Explanation

A. Compartment syndrome is a complication of fractures, particularly when swelling within a closed muscle compartment compromises circulation. However, it typically presents with severe localized pain, paresthesia, pallor, and pulselessness, not systemic symptoms like shortness of breath and chest pain.

B. Hypovolemic shock can occur due to significant blood loss from fractures, but it is characterized by hypotension, tachycardia, and altered mental status rather than chest pain and shortness of breath.

C. Fat embolism syndrome (FES) is a serious complication of long bone fractures. Fat globules from the bone marrow can enter the bloodstream and lodge in the lungs, causing respiratory distress, chest pain, hypoxemia, and sometimes a petechial rash. The timing (24 hours post-injury) and symptoms suggest FES.

D. Venous thromboembolism (VTE) can cause similar symptoms, but it typically develops later than 24 hours post-injury and is less common immediately after fractures compared to FES.

A. Active range-of-motion exercises of the left leg B. Log rolling every 2 hr C. Passive range of motion to the right leg D. Isometric exercises of both legs

Correct Answer is D

Explanation

A. Active range-of-motion exercises of the left leg promote mobility in the unaffected limb but do not fully address the need for maintaining muscle strength in both legs.

B. Log rolling every 2 hours is a technique used for clients who require spinal precautions or have limited movement due to back injuries. It does not promote mobility for a client in Buck's traction.

C. Passive range of motion to the right leg may prevent joint stiffness but does not actively maintain or improve muscle strength. Additionally, movement of the affected limb should be minimized to maintain the alignment of the traction.

D. Isometric exercises of both legs are appropriate for promoting mobility and maintaining muscle strength without disrupting the traction. These exercises involve contracting the muscles without moving the joints, which is safe for the affected limb in Buck's traction.

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A patient is admitted to the respiratory unit with flail chest. The nurse understands that a flail chest is:

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has multiple long bone fractures caused by a motor-vehicle crash that happened 24 hr ago. The client tells the nurse he is short of breath and experiencing chest pain. The nurse should assess the client further for which of the following potential complications?

Correct Answer is C

Explanation

A nurse is caring for an adolescent client whose right leg is in Buck's traction. Which of the following interventions should the nurse implement to promote the client's mobility?

Correct Answer is D

Explanation

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The nurse is assessing the respiratory status of a client who has suffered a fractured rib. Which observation, if made by the nurse, would not be directly related to the fractured rib?

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