A nurse is caring for a client who has a pneumothorax.

Exhibits

A nurse is reviewing the client's medical record. Which of the following prescriptions should the nurse anticipate for a client who has a pneumothorax?

For each potential provider's prescription, click to specify if the potential prescription is anticipated, non-essential, or contraindicated for the client.

Obtain intravenous access

Thoracentesis

Pulmonary Function Tests (PFTS)

Prepare for insertion of a chest tube.

Obtain ABGS

Computed tomography (CT) of the chest

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"}}

Obtain intravenous access: Anticipated: Essential for administering medications, fluids, and potential emergency treatments.
Thoracentesis: Non-essential: Typically used for pleural effusions, not primary treatment for pneumothorax; chest tube insertion is the main treatment.
Pulmonary Function Tests (PFTs): Non-essential: Useful for diagnosing chronic respiratory conditions but not a primary intervention for pneumothorax.
Prepare for insertion of a chest tube: Anticipated: A chest tube is often necessary to re-expand the lung and treat a significant pneumothorax.
Obtain ABGs: Anticipated: Important for assessing the client’s oxygenation and acid-base balance due to respiratory distress.
Computed tomography (CT) of the chest: Anticipated: CT can be used to diagnose the extent of the pneumothorax and guide treatment.

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Correct Answer is A

Explanation

A. Administer oxygen therapy. This is the priority intervention to ensure adequate oxygenation and address hypoxemia due to the pulmonary embolism.

B. Start an IV infusion of lactated Ringer's is not the immediate priority; oxygen therapy addresses acute symptoms of a pulmonary embolism first.

C. Initiate cardiac monitoring is important, but it is secondary to addressing the client's oxygenation needs.

D. Give morphine IV may be part of the treatment plan, but oxygen therapy is the most immediate intervention for a pulmonary embolism.

A. Tachypnea B. Bilateral weakness of extremities C. Decreased level of consciousness D. Hypotension

Correct Answer is C

Explanation

A. Tachypnea is not a primary sign of increased intracranial pressure but might be seen in other conditions.

B. Bilateral weakness of extremities can indicate severe brain injury but is not the most specific sign of increased intracranial pressure.

C. Decreased level of consciousness is a direct sign of increased intracranial pressure affecting brain function.

D. Hypotension is not a typical manifestation of increased intracranial pressure; increased ICP more commonly leads to hypertension.

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Correct Answer is A

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Correct Answer is C

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