A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations leads the nurse to suspect a pneumothorax? (Select all that apply)
(Select All that Apply.)

A. Hospital-acquired pneumonia: Pneumonia that develops 48 hours or more after hospital admission is classified as hospital-acquired pneumonia (HAP). It is caused by pathogens acquired in the hospital setting, often involving multidrug-resistant organisms such as Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA), and Klebsiella pneumoniae. Patients who are intubated, have prolonged hospital stays, or have weakened immune defenses are at higher risk.

B. Immunocompromised pneumonia: Pneumonia in immunocompromised patients occurs due to weakened host defenses, such as in individuals with HIV/AIDS, those undergoing chemotherapy, or transplant recipients on immunosuppressive therapy. While these patients can develop HAP, pneumonia due to opportunistic infections like Pneumocystis jirovecii or fungal infections is categorized separately.

C. Community-acquired pneumonia: Pneumonia acquired outside the hospital or within the first 48 hours of admission is classified as community-acquired pneumonia (CAP). Typical pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. CAP is usually less resistant to antibiotics compared to HAP.

D. Viral pneumonia: Pneumonia caused by viral pathogens such as influenza, respiratory syncytial virus (RSV), or SARS-CoV-2 is classified based on the causative agent rather than the setting in which it was acquired. Although viruses can cause both CAP and HAP, the classification of pneumonia is determined by the timing of onset and exposure risks.

A. Bradycardia: Bradycardia, which is a slower than normal heart rate, is not a typical clinical manifestation of pleural effusion with empyema. In fact, fever and infection usually lead to tachycardia (an increased heart rate) as the body attempts to respond to infection.

B. Pleural pain: Pleural pain is a common symptom associated with pleural effusion and empyema, resulting from irritation of the pleura due to inflammation or infection.

C. Cough: A cough can occur with pleural effusion and empyema, often as a response to irritation or pressure in the thoracic cavity. It may also be associated with underlying lung conditions contributing to the effusion.

D. Fever: Fever is a typical clinical manifestation of empyema, indicating an infectious process. The presence of infection in the pleural space often results in systemic signs of infection, such as fever.