The nurse understands that PEEP is a form of increased pressure, and that when using high levels of PEEP the patient's lung can suffer barotrauma.
If the patient suffers barotrauma resulting in a left-sided pneumothorax, what would the expected assessment findings be?
Absence of lung sounds on the right side.
Absence of lung sounds or chest rise on the left side.
Hypertension and Bradypnea.
Lack of chest rise bilaterally.
The Correct Answer is B
Choice A rationale
The absence of lung sounds on the right side would indicate a problem in the right lung, such as a right-sided pneumothorax or severe atelectasis of the right lung. Given the scenario specifies a left-sided pneumothorax, the primary assessment findings would be localized to the affected (left) side, not the contralateral side.
Choice B rationale
A left-sided pneumothorax, characterized by air accumulating in the pleural space on the left side, will lead to collapse of the left lung. This collapse will result in an absence of breath sounds and diminished or absent chest rise on the affected (left) side due to the lung's inability to inflate and participate in ventilation.
Choice C rationale
Hypertension (elevated blood pressure) and bradypnea (slow respiratory rate) are not typical primary findings in an acute pneumothorax. While a pneumothorax can cause respiratory distress, it often leads to tachypnea (increased respiratory rate) as the body attempts to compensate for reduced lung function and potentially hypotension due to impaired venous return.
Choice D rationale
Lack of chest rise bilaterally would indicate a more generalized respiratory issue, such as severe bilateral atelectasis, bilateral mainstem bronchus obstruction, or a severe neurological impairment affecting respiratory drive. In a unilateral pneumothorax, the contralateral lung would typically still demonstrate some degree of chest rise, although it might be diminished. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B"]
Explanation
Choice A rationale
A disconnection of the ventilator tubing from the patient's airway or from another part of the circuit directly leads to a loss of positive pressure within the system. The ventilator detects this rapid drop in circuit pressure, triggering a low-pressure alarm. This physical separation prevents effective delivery of the set tidal volume and positive end-expiratory pressure, resulting in insufficient ventilation for the patient.
Choice B rationale
Patient self-extubation refers to the accidental or intentional removal of the endotracheal or tracheostomy tube. When this occurs, the connection between the ventilator circuit and the patient's airway is severed. Consequently, the positive pressure generated by the ventilator escapes into the atmosphere, causing a sudden and significant decrease in the circuit pressure, which activates the low-pressure alarm.
Choice C rationale
While a patient laying on the tubing might cause a temporary increase in resistance, it would more likely trigger a high-pressure alarm due to an obstruction or kink in the circuit, which impedes gas flow and increases proximal airway pressure. A low-pressure alarm indicates a leak or disconnection, not an obstruction.
Choice D rationale
Patient coughing can cause a transient increase in intrathoracic pressure and a brief spike in airway pressure within the ventilator circuit. This temporary increase in pressure is more likely to trigger a high-pressure alarm rather than a low-pressure alarm, as it represents a momentary resistance to airflow or expulsion of air.
Choice E rationale
Excessive airway secretions and mucous plugs create an obstruction within the patient's airway or the endotracheal tube. This obstruction increases the resistance to airflow, leading to a build-up of pressure within the ventilator circuit. Therefore, this condition would typically trigger a high-pressure alarm, indicating increased resistance to ventilation, rather than a low-pressure alarm, which signifies a leak or disconnection.
Correct Answer is D
Explanation
Choice A rationale
Pancuronium is a non-depolarizing neuromuscular blocker, but it is not directly linked to malignant hyperthermia. Neostigmine is an acetylcholinesterase inhibitor used to reverse the effects of non-depolarizing neuromuscular blockers by increasing acetylcholine at the neuromuscular junction, not a treatment for malignant hyperthermia.
Choice B rationale
Rocuronium is a non-depolarizing neuromuscular blocker and, while generally safe, is not the primary paralytic associated with malignant hyperthermia. Dantrolene is the specific pharmacological treatment for malignant hyperthermia, acting by inhibiting calcium release from the sarcoplasmic reticulum in muscle cells, reducing muscle rigidity and hypermetabolism.
Choice C rationale
Vecuronium is a non-depolarizing neuromuscular blocker and does not directly trigger malignant hyperthermia. Neostigmine, as previously stated, is a reversal agent for non-depolarizing muscle relaxants and has no role in the treatment of malignant hyperthermia, which requires specific intervention to address altered calcium homeostasis.
Choice D rationale
Succinylcholine, a depolarizing neuromuscular blocker, is the only commonly used paralytic drug that can reliably trigger malignant hyperthermia in susceptible individuals due to its direct interaction with the ryanodine receptor. Dantrolene is the definitive treatment, acting to restore intracellular calcium homeostasis by blocking calcium release from the sarcoplasmic reticulum.
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