A nurse in the PACU is assessing a client who has an endotracheal (ET) tube in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

Blockage of the ET tube by the client's tongue

Movement of the ET tube into the right main bronchus

Infection of the vocal cords

Passage of the ET tube into the esophagus

Answer and Explanation

The Correct Answer is B

A. Blockage of the ET tube by the client's tongue would not typically result in asymmetric chest wall expansion.
B. If the ET tube has moved into the right main bronchus, it will cause more air to enter the right lung and less to the left, leading to decreased left-sided chest wall expansion.
C. Infection of the vocal cords is not related to the absence of chest wall expansion.
D. Passage of the ET tube into the esophagus would lead to the absence of breath sounds in both lungs, not just the left side.

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Correct Answer is B

Explanation

A. Fluids should not be restricted; adequate hydration is necessary to help flush the contrast dye used during the procedure out of the client's system.
B. Performing neurovascular checks with vital signs is essential to monitor for complications such as bleeding, hematoma, or compromised circulation to the extremity.
C. The client should avoid range-of-motion exercises to the lower extremities immediately following the procedure to prevent disruption of the femoral artery site.
D. The client should remain on bed rest for several hours following the procedure to reduce the risk of bleeding at the catheter insertion site.

A. Coffee B. Alcohol C. Milk D. Orange juice

Correct Answer is B

Explanation

A. Coffee has not been shown to significantly increase the risk of gout attacks and may even have a protective effect due to its antioxidant properties.

B. Alcohol, especially beer and spirits, can trigger gout attacks by increasing the level of uric acid in the blood. Alcohol consumption should be limited or avoided to reduce the risk of gout flare-ups.

C. Milk and other low-fat dairy products are actually recommended for people with gout, as they may help lower uric acid levels.

D. Orange juice, while high in vitamin C, does contain fructose, which can increase uric acid production. However, it is not as significant a trigger as alcohol. Moderation is key.

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A nurse in the PACU is assessing a client who has an endotracheal (ET) tube in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

Nursing Test Bank

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