The nurse suspects that a client with pancreatitis has developed hypocalcemia.
Which electrocardiogram finding supports the nurse's suspicion?

Splenic rupture involves internal hemorrhage and peritoneal irritation. Assessing this requires understanding Kehr sign and signs of hypovolemic shock. Knowledge of hemodynamic parameters and abdominal symptoms is essential to identify occult bleeding and impending cardiovascular collapse following trauma.

Choice A rationale

Splenic injury causes blood to accumulate in the peritoneal cavity, leading to abdominal pain and distension. This irritation of the peritoneum is a hallmark sign of internal organ damage following blunt force trauma to the left side.

Choice B rationale

Headaches are not typically associated with splenic injury unless there is concurrent head trauma. While shock can cause lightheadedness, a primary headache is not a specific or supportive clinical indicator for an isolated splenic laceration or rupture.

Choice C rationale

Hypotension occurs as a result of significant internal bleeding and decreased circulating blood volume. Blood pressure falls below the normal systolic range of 90 to 120 mmHg as the body fails to compensate for acute blood loss.

Choice D rationale

Tachycardia is a compensatory mechanism where the heart rate increases above 100 beats per minute to maintain cardiac output during hemorrhage. It is often one of the earliest signs of volume depletion and internal splenic bleeding.

Choice E rationale

Polyuria, or excessive urination, is not a sign of splenic injury or hypovolemia. In fact, blood loss usually leads to oliguria, where urine output drops below 30 mL per hour as the kidneys conserve fluid and sodium.

Choice F rationale

Wide pulse pressure is often seen in conditions like aortic regurgitation or increased intracranial pressure. Splenic rupture causes hypovolemia, which typically results in a narrow pulse pressure as the systolic pressure falls and diastolic pressure stays.

Choice G rationale

Nausea is a common symptom of peritoneal irritation and the systemic response to acute internal bleeding. The presence of blood in the abdominal cavity can stimulate the vagus nerve and gastrointestinal distress, leading to vomiting or nausea.

The nurse must utilize knowledge of thoracic drainage mechanics and equipment troubleshooting. A three-chamber system requires consistent suction to maintain negative pleural pressure. Identifying the cause of suction failure involves systematic assessment of the external vacuum source and tube integrity.

Choice A rationale

Suction control chambers in wet systems require active external suction to function. Bubbling indicates vacuum application. Verifying the regulator is on ensures the system has the mechanical force necessary to maintain the ordered negative pressure for lung re-expansion.

Choice B rationale

Milking or stripping chest tubes creates high levels of negative pressure that can damage delicate lung tissue. This practice is generally contraindicated unless specifically ordered by a surgeon, as it increases the risk of pleural trauma and tension pneumothorax.

Choice C rationale

Absence of bubbling in the suction control chamber of a wet system is an abnormal finding. It signifies a lack of active suctioning. The nurse cannot ignore this, as effective pleural drainage depends on continuous atmospheric pressure regulation.

Choice D rationale

While water levels dictate suction intensity, adding water will not resolve a lack of bubbling if the suction source is off. Bubbling is caused by air passing through water via the suction regulator, not the volume itself.