A nurse is collecting data for 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
A. Respiratory alkalosis: Respiratory alkalosis is generally associated with hyperventilation and is not directly caused by tension pneumothorax. In tension pneumothorax, the primary issues are related to pressure changes within the thoracic cavity, not respiratory alkalosis.
B. Increased venous return: In tension pneumothorax, venous return is actually decreased due to the increased intrathoracic pressure compressing the great vessels, which impedes blood flow back to the heart.
C. Decreased cardiac output: Tension pneumothorax causes a significant increase in intrathoracic pressure, leading to compression of the heart and great vessels, which results in decreased venous return and ultimately decreased cardiac output. This is a critical and life-threatening consequence of tension pneumothorax.
D. Dilated ventricles: Dilated ventricles are more commonly seen in chronic heart conditions such as heart failure, rather than in acute tension pneumothorax. Tension pneumothorax typically results in reduced ventricular filling rather than dilation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Avoid vitamin supplements during therapy: This is not generally advised for isoniazid therapy. In fact, vitamin B6 supplements are often recommended to prevent peripheral neuropathy caused by isoniazid.
B. Drink alcohol in small amounts only: Alcohol can increase the risk of liver toxicity when taking isoniazid. It is typically advised to avoid alcohol altogether during treatment.
C. Report yellow eyes or skin immediately: Isoniazid can cause liver toxicity, which can lead to jaundice (yellowing of the eyes and skin). This is a serious side effect and should be reported immediately to prevent further liver damage.
D. Increase intake of Swiss or aged cheeses: This recommendation is not related to isoniazid therapy. Aged cheeses are more relevant to patients on monoamine oxidase inhibitors (MAOIs) due to tyramine content.
Correct Answer is A
Explanation
A. Bronchospasm occurs when there is inflammation, edema, and excess mucus: Bronchospasm in asthma is characterized by inflammation of the airways, edema of the airway walls, and increased mucus production, leading to constriction and obstruction of the airways.
B. Decreased mucus production contributes to airway constriction: In asthma, bronchospasm is associated with increased mucus production, not decreased. Excess mucus contributes to airway obstruction.
C. Inflammation is reduced due to airway diameter: Inflammation typically increases airway constriction rather than reducing it. The narrowed airway diameter is a result of inflammation, not a reduction in inflammation.
D. Airway obstruction occurs due to thinning mucus: Airway obstruction in asthma is due to thick, tenacious mucus, not thinning mucus. The mucus contributes to the blockage of the airways.
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