John, a 35-year-old male involved in a motor vehicle accident, presents with a contusion across his chest from the seatbelt. Which two combined assessments should the nurse prioritize to detect potential complications?
Assess for sternal tenderness and check for skin abrasions.
Assess for sternal tenderness and measure oxygen saturation levels.
Measure blood pressure and observe for signs of localized infection
Measure oxygen saturation levels and auscultate lung sounds
The Correct Answer is D
A. While assessing sternal tenderness is relevant, skin abrasions may not directly indicate complications from the chest contusion.
B. Sternal tenderness can indicate underlying injuries but is not the priority compared to auscultation of the lung zones, and measuring oxygen saturation levels is crucial for assessing respiratory function and detecting potential complications such as respiratory distress or hypoxemia.
C. Blood pressure measurement and observation for signs of localized infection are important assessments but may not be directly related to complications from a chest contusion.
D. This is because a contusion across the chest from the seatbelt can cause rib fractures, pneumothorax, hemothorax, or pulmonary contusion, which can impair gas exchange and oxygenation. Measuring oxygen saturation levels and auscultating lung sounds can help detect these complications and guide appropriate interventions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Immunofixation electrophoresis is not primarily used to assess kidney function.
B. Immunofixation electrophoresis is not used to assess lung function.
C. Immunofixation electrophoresis is a laboratory technique used to identify and characterize abnormal proteins in the blood, which is essential in diagnosing conditions like Waldenstrom's macroglobulinemia.
D. Immunofixation electrophoresis is not used to quantify white blood cells (WBCs).
Correct Answer is D
Explanation
A. This mechanism helps to remove particles and microorganisms from the air before they enter the lungs but is not primarily responsible for removing pathogens already present in the lungs.
B. Bronchoconstriction typically occurs in response to irritants or allergens and is not directly involved in removing pathogens.
C. While alveolar macrophages play a role in immune defense within the lungs, they are not the primary mechanism for removing pathogens causing pneumonia.
D. The cough reflex is the body's primary mechanism for expelling pathogens and debris from the respiratory tract, making it the most appropriate choice in this scenario.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.