A nurse is assessing a client who has tension pneumothorax. Which of the following findings should the nurse expect following tracheal deviation?
Respiratory alkalosis
Increased venous return
Decreased cardiac output
Dilated ventricles
The Correct Answer is C
Choice A Reason:
Respiratory alkalosis is incorrect. Tension pneumothorax typically leads to respiratory distress and hypoxemia rather than respiratory alkalosis. The respiratory alkalosis may occur initially due to hyperventilation in response to hypoxemia but would not be directly related to tracheal deviation.
Choice B Reason:
Increased venous return is incorrect. Tension pneumothorax actually leads to decreased venous return due to compression of the great vessels in the thorax, particularly the superior vena cava and the inferior vena cava. This compression results from the increased pressure within the thorax, which impedes blood flow back to the heart.
Choice C Reason:
Decreased cardiac output is incorrect. Tension pneumothorax can indeed lead to decreased cardiac output due to compression of the heart and the great vessels by the accumulating air in the pleural space. This compression decreases venous return and impairs cardiac function.
Choice D Reason:
Dilated ventricles is incorrect. As mentioned earlier, tension pneumothorax can lead to compression of the heart, including the ventricles. This compression can cause dilatation of the ventricles, particularly the right ventricle, due to increased afterload and decreased venous return.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
Choice A Reason:
Bladder spasms are not commonly reported as adverse effects of methylprednisolone. However, bladder dysfunction can occur in individuals with multiple sclerosis due to the disease process itself, but it is not specifically related to corticosteroid therapy.
Choice B Reason:
Hypotension is not a common adverse effect of methylprednisolone. In fact, corticosteroids can often lead to fluid retention and sodium retention, which can contribute to hypertension rather than hypotension.
Choice C Reason:
Delayed wound healing is correct. Corticosteroids can impair the body's ability to heal wounds by suppressing the inflammatory response and collagen synthesis. Therefore, clients receiving methylprednisolone may experience delayed wound healing, which can be problematic, especially in individuals with pre-existing wounds or undergoing surgical procedures.
Choice D Reason:
Hirsutism (excessive hair growth, especially in women) can occur with long-term corticosteroid use due to the effect of steroids on hair follicles. It is a possible adverse effect of methylprednisolone.
Choice E Reason:
Hyperglycemia is correct. Corticosteroids can increase blood glucose levels by promoting gluconeogenesis, reducing glucose uptake by tissues, and inducing insulin resistance. Clients receiving methylprednisolone may develop hyperglycemia, which can be particularly concerning for individuals with diabetes or those at risk of developing diabetes.
Correct Answer is B
Explanation
Choice A Reason:
Nutritional therapy is not appropriate. While nutritional therapy may be involved in assessing the client's overall nutritional status and dietary needs, it may not specifically address the swallowing difficulty associated with Parkinson's disease.
Choice B Reason:
Speech therapy is appropriate. Speech therapy, also known as speech-language pathology, plays a crucial role in assessing and managing dysphagia. Speech therapists can evaluate the client's swallowing function and provide interventions to improve swallowing safety and efficiency.
Choice C Reason:
Occupational therapy is incorrect. Occupational therapy focuses on helping individuals engage in meaningful activities of daily living. While occupational therapists may play a role in dysphagia management, speech therapy is typically the primary discipline involved in addressing swallowing difficulties.
Choice D Reason:
Respiratory therapy: Respiratory therapy primarily focuses on evaluating and managing respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and ventilator support. While dysphagia can sometimes lead to aspiration pneumonia and respiratory complications, respiratory therapists are not typically involved in the assessment and management of dysphagia itself.
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