During a central IV line insertion at the bedside, a client reports shortness of breath and becomes tachypneic. Which finding should a nurse suspect indicates the client developed a pneumothorax?

Muffled heart sounds.

Sudden hemoptysis.

Absent breath sounds on the affected side.

Declining respiratory rate.

Answer and Explanation

The Correct Answer is C

Choice A rationale
Muffled heart sounds are not a typical sign of pneumothorax. They are more commonly associated with conditions such as pericardial effusion or cardiac tamponade.
Choice B rationale
Sudden hemoptysis, or coughing up blood, is not a typical sign of pneumothorax. It is more commonly associated with conditions such as pulmonary embolism or lung cancer.
Choice C rationale
Absent breath sounds on the affected side is a typical sign of pneumothorax. When air enters the pleural space and causes the lung to collapse, breath sounds may be absent or significantly decreased on the affected side.
Choice D rationale
A declining respiratory rate is not a typical sign of pneumothorax. In fact, a rapid respiratory rate (tachypnea) is more commonly observed in pneumothorax due to the body’s attempt to compensate for the decreased lung capacity.

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Correct Answer is B

Explanation

Choice A rationale
A chocolate milkshake may be soothing, but it is not the best choice for a patient with bacterial pharyngitis due to its high sugar content, which can promote bacterial growth.
Choice B rationale
Chicken noodle soup is a good choice as it is soothing, easy to swallow, and provides necessary nutrients.
Choice C rationale
Vanilla ice cream, while soothing, is not the best choice due to its high sugar content.
Choice D rationale
Fruit-flavored popsicles, while soothing, are not the best choice due to their high sugar content.

A. Cherry jello. B. Clear broth soup. C. Chicken noodle soup. D. Cream of potato soup.

Correct Answer is D

Explanation

Choice A rationale
Cherry jello is not a part of a full-liquid diet. While it is soft and easy to swallow, it does not provide the necessary nutrients that a patient recovering from surgery for laryngeal cancer would need.
Choice B rationale
Clear broth soup is part of a clear liquid diet, not a full liquid diet. A full liquid diet includes foods that are liquid at room temperature or melt at body temperature.
Choice C rationale
Chicken noodle soup is not suitable for a full-liquid diet. The noodles and chicken pieces could pose a swallowing risk for a patient recovering from surgery for laryngeal cancer.
Choice D rationale
Cream of potato soup is a suitable choice for a full-liquid diet. It is smooth and easy to swallow, and it provides necessary nutrients.

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During a central IV line insertion at the bedside, a client reports shortness of breath and becomes tachypneic. Which finding should a nurse suspect indicates the client developed a pneumothorax?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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