Exhibits

What is the most appropriate initial management for this patient?

Apply positive pressure ventilation and provide supportive care with pain management.

Perform needle decompression of the pleural space followed by chest tube insertion.

Administer intravenous antibiotics and arrange for an elective surgical repair.

Provide high-flow oxygen and intubate the patient for mechanical ventilation.

Answer and Explanation

The Correct Answer is B

A. Apply positive pressure ventilation and provide supportive care with pain management: While supportive care is important, positive pressure ventilation may not be sufficient to address the underlying issue, which is likely a pneumothorax or hemothorax.
B. Perform needle decompression of the pleural space followed by chest tube insertion: This is the most appropriate initial management for a patient with paradoxical chest wall movement, which is a sign of flail chest and likely pneumothorax. Needle decompression can relieve pressure in the pleural space, and chest tube insertion can help drain any fluid or air that has accumulated.
C. Administer intravenous antibiotics and arrange for an elective surgical repair: While infection may be a concern, it is not the most immediate priority in this case. The patient's respiratory distress needs to be addressed first.
D. Provide high-flow oxygen and intubate the patient for mechanical ventilation: While oxygen therapy may be necessary, intubation should be considered as a last resort if other measures fail to improve oxygenation. In this case, needle decompression and chest tube insertion are more likely to be effective in improving respiratory function.

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Correct Answer is B

Explanation

A. Hyperventilate the client with 100% oxygen before suctioning the airway: Hyperventilation before suctioning is a method to prevent hypoxia, not to thin secretions. It does not affect the viscosity of secretions.

B. Provide humidified oxygen: Humidified oxygen helps to moisten the airways, which can thin secretions, making them easier to clear. This is an appropriate intervention for managing tenacious secretions in a client with a tracheostomy.

C. Perform chest physiotherapy prior to suctioning: Chest physiotherapy helps mobilize secretions but does not thin them. While useful in clearing airways, it is not a direct method for thinning secretions.

D. Prelubricate the suction catheter tip with sterile saline when suctioning the airway: Prelubricating the suction catheter is done to reduce friction and trauma during suctioning but does not impact the thickness of the secretions.

A. Impaired carbon dioxide elimination due to shunting B. Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch C. Hypoxemia due to dead space D. Decreased pulmonary compliance due to stiffness

Correct Answer is D

Explanation

A. Impaired carbon dioxide elimination due to shunting: Shunting in ARDS affects oxygenation rather than carbon dioxide elimination. ARDS primarily results in impaired gas exchange due to inflammation and fluid accumulation in the alveoli, affecting oxygen rather than CO2.

B. Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch: ARDS typically leads to increased pulmonary arterial pressure due to inflammation and decreased lung compliance. The V/Q mismatch contributes to impaired gas exchange, often resulting in elevated pulmonary arterial pressure rather than decreased.

C. Hypoxemia due to dead space: In ARDS, hypoxemia is primarily due to impaired gas exchange from damaged alveoli, not due to dead space. Dead space refers to areas where ventilation occurs without adequate blood flow, which is not the main issue in ARDS.

D. Decreased pulmonary compliance due to stiffness: ARDS is characterized by decreased pulmonary compliance due to the stiffness of the lung tissue caused by inflammation and edema. This decreased compliance makes lung expansion more difficult, which is a central feature of ARDS.

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Exhibits What is the most appropriate initial management for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postoperative following a tracheostomy and has copious and tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin this client's secretions?

Correct Answer is B

Explanation

A nurse is collecting data for a client who has acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

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A nurse is assessing a client who has respiratory alkalosis. Which of the following findings should the nurse expect?

Exhibits Which of the following is the most appropriate treatment strategy for this patient, who is likely experiencing allergic rhinitis?

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Exhibits

What is the most appropriate initial management for this patient?