A nurse is caring for a client who has acute respiratory distress syndrome (ARDS) and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes?

Choice A reason: Repositioning the client toward the left side is not necessary or helpful for a client who has a three-chamber closed chest tube system. The chest tube drainage system must always be placed below the drainage site and secured in an upright position to prevent it from being knocked over.

Choice B reason: Continuing to monitor the client is the appropriate action for the nurse to take after noticing a rise in the water seal chamber with client inspiration. The water in the water seal chamber should rise with inhalation and fall with exhalation (this is called tidaling), which demonstrates that the chest tube is patent. This is a normal finding and does not indicate a problem with the chest tube system or the client's condition.

Choice C reason: Clamping the chest tube near the water seal is not recommended for a client who has a three-chamber closed chest tube system. Clamping the chest tube can cause a buildup of air or fluid in the pleural space and increase the risk of complications such as tension pneumothorax or infection. Clamping the chest tube should only be done in certain situations, such as changing the drainage system, checking for an air leak, or removing the chest tube.

Choice D reason: Immediately notifying the provider is not necessary for a client who has a three-chamber closed chest tube system and shows a rise in the water seal chamber with client inspiration. As mentioned above, this is a normal finding and does not indicate a problem with the chest tube system or the client's condition. The nurse should only notify the provider if there are signs of complications, such as continuous bubbling in the water seal chamber, excessive drainage, chest pain, dyspnea, or subcutaneous emphysema.

Choice A reason: Decrease respiratory secretions. This answer is incorrect because pancuronium does not have any effect on the production or clearance of respiratory secretions. This medication is not used to treat the pulmonary edema and inflammation that occur in ARDS.

Choice B reason: Induce sedation. This answer is incorrect because pancuronium does not have any sedative or analgesic properties. This medication does not affect the level of consciousness or pain perception of the client. A client who receives pancuronium should also receive adequate sedation and analgesia to prevent anxiety and discomfort.

Choice C reason: Suppress respiratory effort. This answer is correct because pancuronium is a neuromuscular blocker that inhibits the transmission of nerve impulses to the muscles, causing paralysis and relaxation. This medication is used to suppress the respiratory effort of the client and allow the mechanical ventilator to control the breathing.

Choice D reason: Decrease chest wall compliance. This answer is incorrect because pancuronium does not have any effect on the elasticity or stiffness of the chest wall. This medication is not used to treat the reduced lung compliance and increased airway resistance that occur in ARDS.