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 ["250"]

Explanation

- Total volume of IV fluid: 2000 mL

- Total time for infusion: 8 hours

Infusion rate: 2000/8 = 250ml/hr

=250

A. Instruct the client on the use of crutches. B. Perform neurovascular checks of the extremities. C. Medicate the client for pain. D. Direct the client to perform exercises of the ankle and toes.

Correct Answer is B

Explanation

A. Instructing the client on the use of crutches is important but not as immediately critical as monitoring for complications.

B. Performing neurovascular checks of the extremities is the most important action to detect complications such as compartment syndrome or impaired circulation.

C. Medicating the client for pain is important but secondary to immediate assessment for complications.

D. Directing the client to perform exercises of the ankle and toes is important for recovery but not as urgent as monitoring for postoperative complications.

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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

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer 0.45% sodium chloride (NaCl) 2000 mL IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["250"]

Explanation

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

Correct Answer is B

Explanation

A nurse is reviewing the laboratory values of a client who is at risk for disseminated intravascular coagulopathy (DIC). Which of the following values should the nurse report to the provider?

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A nurse is completing discharge teaching with a client following arthroscopic knee surgery. Which of the following instructions should the nurse include in the teaching?

A nurse is teaching an assistive personnel (AP) about the purpose of a footplate on the bed of a client whose leg is in Buck's traction. Which of the following statements indicates the AP understands the teaching?

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