The patient has an order for Coumadin 3.75 mg today.

The pill from the pharmacy is 2.5 mg. How many pills would you give?

Choice A rationale

When a chest tube is accidentally removed, the first priority is to prevent air from entering the pleural space. An occlusive dressing, secured on three sides, acts as a one-way valve, allowing air to escape during exhalation but preventing air from being sucked back in during inhalation. This prevents the development of a tension pneumothorax.

Choice B rationale

While the health care provider must be notified, it is not the first action. The immediate priority is to address the life-threatening risk of a tension pneumothorax. Securing the site with an occlusive dressing takes precedence over contacting the physician.

Choice C rationale

The patient's position is not the initial priority. The immediate and life-saving intervention is to cover the open wound to prevent air from entering the chest cavity, which can lead to a pneumothorax. Positioning the patient is a subsequent action.

Choice D rationale

Reinserting the chest tube is an invasive procedure that must be performed by a qualified health care provider under sterile conditions. A nurse should never attempt to reinsert a chest tube, as this poses a significant risk of infection and injury to the patient. *.

Choice A rationale

Tachypnea, or an increased respiratory rate, is a compensatory mechanism initiated by the body in response to decreased oxygen availability. A pneumothorax causes lung collapse, reducing the surface area for gas exchange. This leads to hypoxemia and hypercapnia, which stimulate chemoreceptors in the brainstem to increase the respiratory rate and depth, in an attempt to improve ventilation and oxygenation. The normal respiratory rate for an adult is 12 to 20 breaths per minute.

Choice B rationale

A pneumothorax causes a collapsed lung, leading to significant respiratory distress. Patients will instinctively increase the use of accessory muscles, such as the scalenes and sternocleidomastoid, to help lift the rib cage and expand the chest cavity to increase the negative intrathoracic pressure needed for inspiration. Decreased use of these muscles would suggest an improvement in the patient's respiratory status, which is not expected with a pneumothorax.

Choice C rationale

A pneumothorax, especially a tension pneumothorax, can lead to a state of hypoxemia and hypercapnia, which triggers the sympathetic nervous system. The sympathetic response increases heart rate to improve cardiac output and oxygen delivery to the tissues. Therefore, tachycardia, not bradycardia, is a more common finding. Normal heart rate is 60 to 100 beats per minute.

Choice D rationale

Tracheal deviation is a critical late sign of a tension pneumothorax, a life-threatening condition where air accumulates in the pleural space and shifts the mediastinum away from the affected side. This shift can compress the great vessels and the unaffected lung, causing severe hemodynamic compromise and respiratory failure. The deviation is a result of the high pressure pushing the trachea to the side opposite the injury.

Choice E rationale

Pleuritic pain is a sharp, stabbing chest pain that is often described as being worse with inspiration or coughing. It is a classic symptom of pneumothorax, resulting from the irritation of the parietal pleura by the air that has escaped into the pleural space. The parietal pleura contains nerve endings, and its inflammation or irritation leads to this specific type of pain.