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?

Pleural effusion on the unaffected side

Shallow breathing due to pain

Guarding behavior when taking deep breaths

Localized chest pain on inspiration

Answer and Explanation

The Correct Answer is A

A. Pleural effusion on the unaffected side is not directly related to a fractured rib. While rib fractures can lead to complications such as pneumothorax or hemothorax, pleural effusion on the opposite side is likely caused by another condition, such as infection or malignancy, and should be investigated separately.

B. Shallow breathing due to pain is a common response to a fractured rib, as the client may avoid deep breaths to minimize discomfort.

C. Guarding behavior when taking deep breaths is directly related to the pain caused by the fractured rib and is an expected observation.

D. Localized chest pain on inspiration is a hallmark symptom of a fractured rib, as the injury causes discomfort with chest wall movement during breathing.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A. Oxygen at 4L per minute is generally too high for clients with COPD. High oxygen concentrations can suppress their hypoxic drive, which is their primary mechanism for breathing.

B. Oxygen at 2L per minute is the appropriate starting rate for clients with COPD. This flow rate provides supplemental oxygen without significantly increasing the risk of suppressing the client’s respiratory drive.

C. Oxygen at 6L per minute is excessive for clients with COPD and can lead to complications such as hypercapnia or respiratory depression.

D. Oxygen at 8L per minute is not recommended for clients with COPD unless specifically ordered in a life-threatening situation, as it can suppress their respiratory drive and worsen their condition.

A. Crepitus in the area above and surrounding the insertion site. B. Eyelets are not visible. C. Bubbling of the water in the water seal chamber with exhalation. D. Movement of the trachea toward the unaffected side.

Correct Answer is D

Explanation

A. Crepitus, or subcutaneous emphysema, near the insertion site can occur due to air leaking into the subcutaneous tissue. While it should be monitored, it does not always require immediate provider notification unless it is extensive or worsening.

B. The absence of visible eyelets indicates the chest tube is properly positioned within the pleural space. This is an expected finding and does not require provider notification.

C. Bubbling of the water in the water seal chamber with exhalation is normal in a client with a pneumothorax. It indicates air is being evacuated from the pleural space.

D. Movement of the trachea toward the unaffected side is a sign of tension pneumothorax, a life-threatening complication. This finding requires immediate notification of the provider and emergency intervention to relieve the pressure in the pleural space.

View Question and Answer

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

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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is applying oxygen via nasal cannula to a client diagnosed with chronic obstructive pulmonary disease (COPD). The client reports extreme shortness of breath. At what rate should the nurse set the flowmeter?

Correct Answer is B

Explanation

A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

Correct Answer is D

Explanation

A client is admitted to the emergency room with an asthma attack. To decrease the client's dyspnea and anxiety, which of the following interventions will the nurse perform?

A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions should the nurse implement first?

A 70-year-old client in a nursing home is found wandering in the hall and has a new onset confusion. Which action should the registered nurse implement ́ first?

A nurse is caring for a client diagnosed with a fractured left tibia and fibula. Which data should the nurse report to the healthcare provider immediately?

The nurse is caring for a client diagnosed with end-stage chronic obstructive pulmonary disease (COPD). Which of the following data warrants immediate intervention by the nurse?

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?

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD) and a prescription for oxygen therapy at 4L/min via nasal cannula. Which of the following actions should the nurse take?