A patient's endotracheal tube is not secured tightly.
Another nurse assists you in taping the tube.
After you are finished, you auscultate the patient's lungs and note that the breath sounds over the left lung fields are absent.
You suspect that:
the earpiece on your stethoscope is defective.
the patient has a left pneumothorax.
the endotracheal tube is in the right mainstem bronchus.
the patient has aspirated secretions during the procedure.
The Correct Answer is C
Choice A rationale
While equipment failure is a possibility in clinical settings, it is statistically unlikely for a stethoscope earpiece to fail exactly after a tube-securing procedure. A defective earpiece would typically result in diminished or absent sounds bilaterally rather than a localized absence on the left side only. Nurses must first prioritize physiological and procedural complications before assuming mechanical failure. Immediate troubleshooting should focus on the patient's airway anatomy and the placement of the endotracheal tube.
Choice B rationale
A pneumothorax involves the presence of air in the pleural space, which can cause lung collapse and absent breath sounds. While this is a serious complication, it is less common immediately following the simple act of retaping an endotracheal tube. Pneumothorax usually presents with sudden respiratory distress, tracheal deviation, and pleuritic chest pain. In this specific scenario, the mechanical movement of the tube during the securing process points more directly toward a displacement into the airway branches.
Choice C rationale
The right mainstem bronchus is more vertical, shorter, and wider than the left, making it the most frequent site for accidental tube migration. If an endotracheal tube is pushed too far during securing, it will likely enter the right side, effectively bypassing the left lung. This results in normal breath sounds on the right but absent sounds on the left. The nurse must recognize this anatomical predisposition and prepare to withdraw the tube slightly to restore bilateral ventilation.
Choice D rationale
Aspiration of secretions can cause crackles, rhonchi, or diminished breath sounds, but it rarely causes a total and sudden absence of sound across all left lung fields. Aspiration usually leads to localized consolidation or chemical pneumonitis over a longer period. The acute nature of the change immediately after manipulating the tube strongly suggests a mechanical displacement. Suctioning might be necessary, but the priority is confirming the depth of the tube via auscultation and chest radiography.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Dopamine is a potent vasopressor and inotropic agent used in septic shock to improve hemodynamic stability. At moderate to high doses, it stimulates beta-1 adrenergic receptors to increase myocardial contractility and alpha-adrenergic receptors to induce peripheral vasoconstriction. These combined actions result in an increased stroke volume and systemic vascular resistance, effectively raising the cardiac output and the mean arterial pressure. This is essential for maintaining adequate tissue perfusion when intravenous fluids alone fail.
Choice B rationale
Dopamine does not primarily act to decrease preload; in fact, its vasoconstrictive properties may increase venous return to the heart, potentially maintaining or slightly increasing preload. Preload reduction is typically achieved through diuretics or venous vasodilators like nitroglycerin. In the context of septic shock, the therapeutic goal is to support blood pressure and flow rather than reducing the volume or pressure within the ventricles before contraction, which could further compromise the patient's precarious hemodynamic state.
Choice C rationale
Dopamine actually increases myocardial oxygen consumption rather than decreasing it. By increasing the heart rate through its chronotropic effects and enhancing the force of contraction through its inotropic effects, the heart must work harder and requires more oxygen. This can be a significant side effect, especially in patients with underlying coronary artery disease. The drug is used in shock because the benefit of improving systemic perfusion outweighs the risk of increased cardiac oxygen demand.
Choice D rationale
Dopamine typically increases afterload because it causes systemic vasoconstriction via alpha-receptors, especially at higher infusion rates. Afterload is the resistance the heart must pump against to eject blood. In septic shock, systemic vascular resistance is pathologically low due to massive vasodilation. Therefore, increasing afterload is a desired therapeutic effect to restore vascular tone and ensure that the mean arterial pressure remains high enough to perfuse vital organs like the brain and kidneys.
Correct Answer is A
Explanation
Choice A rationale
Paroxysmal supraventricular tachycardia (PSVT) is characterized by a sudden onset and termination of a rapid heart rate, often triggered by a premature atrial contraction (PAC). The heart rate typically ranges from 150 to 250 beats/min. Because the rhythm resolved spontaneously without medical intervention, it fits the definition of "paroxysmal.”. The mechanism involves a re-entry circuit in the conduction system, leading to a rapid, regular rhythm that originates above the ventricles, often seen in otherwise healthy individuals.
Choice B rationale
Ventricular fibrillation is a chaotic, lethal cardiac rhythm characterized by a lack of discernible P waves, QRS complexes, or T waves. The ventricles merely quiver, resulting in no effective cardiac output or pulse. It does not resolve spontaneously and requires immediate defibrillation and cardiopulmonary resuscitation to prevent death. A heart rate of 170 beats/min with a history of PACs and spontaneous resolution is inconsistent with the disorganized electrical activity seen in ventricular fibrillation.
Choice C rationale
Atrial flutter is characterized by a "sawtooth" pattern of F-waves on the ECG, usually with a regular atrial rate of 250 to 350 beats/min and a varying ventricular response. While it can cause a heart rate of 170 beats/min, it is less likely to be triggered by a single PAC and resolve spontaneously in a paroxysmal manner compared to PSVT. Atrial flutter typically requires pharmacological intervention or cardioversion to return the patient to a normal sinus rhythm.
Choice D rationale
Ventricular tachycardia (VT) originates in the ventricles and is characterized by wide, bizarre QRS complexes (usually >0.12 seconds) and a rate typically between 100 and 250 beats/min. While VT can be paroxysmal, it is usually triggered by premature ventricular contractions (PVCs) rather than premature atrial contractions (PACs). The clinical description of the rhythm being initiated by a PAC strongly points toward a supraventricular origin rather than a ventricular one, making VT less likely.
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