Chapter 30: Pneumothorax Flashcards
(48 cards)
A patient with a suspected pneumothorax is being assessed. Which of the following findings is most indicative of a pneumothorax?
A. Subcutaneous emphysema
B. Tracheal deviation
C. Absence of breath sounds over the affected area
D. Hyperresonance on percussion
C. Absence of breath sounds over the affected area
Rationale: Breath sounds are absent over the affected area in a pneumothorax due to the presence of air in the pleural space preventing lung expansion.
Which of the following would be a likely initial clinical manifestation of a small pneumothorax?
A. Severe chest pain
B. Mild tachycardia and dyspnea
C. Cyanosis
D. Hypotension
B. Mild tachycardia and dyspnea
Rationale: A small pneumothorax may present with mild tachycardia and dyspnea as the initial symptoms.
What is the primary cause of a lung collapse in a pneumothorax?
A. Air entering the pleural cavity
B. Infection
C. Accumulation of fluid in the pleural space
D. Increased thoracic pressure from a cough
A. Air entering the pleural cavity
Rationale: A pneumothorax is caused by air entering the pleural cavity, which disrupts the negative pressure needed to keep the lungs inflated, leading to lung collapse.
A patient presents with a penetrating chest wound described as a “sucking chest wound.” What is the immediate concern for this patient?
A. Risk of infection
B. Fluid accumulation in the pleural space
C. Hypoxia due to decreased alveolar ventilation
D. Air entering the pleural space during inspiration
D. Air entering the pleural space during inspiration
Rationale: A “sucking chest wound” allows air to enter the pleural space during inspiration, which can cause a pneumothorax and subsequent lung collapse.
What diagnostic test is commonly used to confirm the presence of a pneumothorax?
A. MRI
B. CT Scan
C. Chest X-ray
D. Ultrasound
C. Chest X-ray
Rationale: A chest X-ray is commonly used to confirm the presence of a pneumothorax by showing air or fluid in the pleural space and reduced lung volume.
A patient with a larger pneumothorax presents with respiratory distress. Which of the following signs would you expect to find upon assessment?
A. Decreased respiratory rate
B. Shallow, rapid respirations
C. Normal oxygen saturation
D. Eupnea
B. Shallow, rapid respirations
Rationale: A larger pneumothorax can cause significant respiratory distress, which often manifests as shallow, rapid respirations.
Which of the following best describes the pleural space in the context of a normal functioning respiratory system?
A. Filled with air to facilitate lung movement
B. A space with positive pressure
C. Contains a few milliliters of lubricating fluid to reduce friction
D. The main site of gas exchange in the lungs
C. Contains a few milliliters of lubricating fluid to reduce friction
Rationale: The pleural space normally contains a few milliliters of lubricating fluid to reduce friction when the tissues move.
What type of pneumothorax can occur without any external wound?
A. Open pneumothorax
B. Closed pneumothorax
C. Tension pneumothorax
D. Spontaneous pneumothorax
B. Closed pneumothorax
Rationale: A closed pneumothorax occurs without any external wound, whereas an open pneumothorax involves air entering through an opening in the chest wall.
A nurse is caring for a young, tall, thin male who is a smoker and has a history of asthma. Which of the following conditions is he at an increased risk for?
A. Spontaneous pneumothorax
B. Pleural effusion
C. Pulmonary embolism
D. Pneumonia
A. Spontaneous pneumothorax
Rationale: The patient’s risk factors, such as being tall and thin, male gender, smoking, and having a history of asthma, increase the likelihood of spontaneous pneumothorax due to the formation of small blebs on the lung surface.
A patient with chronic obstructive pulmonary disease (COPD) is diagnosed with a spontaneous pneumothorax. Which of the following is the most likely cause of the pneumothorax?
A. Rupture of small blebs on the lung surface
B. A severe asthma attack
C. An underlying pneumonia infection
D. Pulmonary embolism
A. Rupture of small blebs on the lung surface
Rationale: In COPD patients, spontaneous pneumothorax often occurs due to the rupture of small blebs, which are air-filled sacs that can form on the surface of the lungs.
A nurse is teaching a patient with a history of spontaneous pneumothorax about risk factors. Which statement by the patient indicates a need for further education?
A. “I should avoid smoking to prevent bleb formation.”
B. “Being tall and thin can increase my risk for pneumothorax.”
C. “I am at higher risk because I have asthma.”
D. “A previous spontaneous pneumothorax doesn’t increase my risk for future ones.”
D. “A previous spontaneous pneumothorax doesn’t increase my risk for future ones.”
Rationale: Having a previous spontaneous pneumothorax actually increases the risk of having another one, so the statement shows a misunderstanding and requires further education.
A 25-year-old male patient with no significant medical history presents with sudden chest pain and shortness of breath. He is tall and thin and has been smoking for several years. What is the most likely diagnosis?
A. Spontaneous pneumothorax
B. Acute asthma exacerbation
C. Myocardial infarction
D. Tension pneumothorax
A. Spontaneous pneumothorax
Rationale: This patient’s sudden chest pain and shortness of breath, combined with risk factors such as being tall and thin, smoking, and male gender, suggest spontaneous pneumothorax, especially since he has no significant medical history.
A nurse is monitoring a patient with spontaneous pneumothorax who has been treated with oxygen therapy and observation. Which of the following would indicate that the patient’s condition is worsening?
A. Increase in respiratory rate and effort
B. Decrease in oxygen saturation
C. Sudden onset of sharp, localized chest pain
D. All of the above
D. All of the above
Rationale: Worsening spontaneous pneumothorax is indicated by increased respiratory rate and effort, decreased oxygen saturation, and sharp chest pain, as these signs suggest that the pneumothorax is not resolving and may require further intervention.
A patient undergoing subclavian catheter insertion develops a pneumothorax. The nurse recognizes that this type of pneumothorax is most likely classified as:
A. Spontaneous pneumothorax
B. Traumatic pneumothorax
C. Iatrogenic pneumothorax
D. Tension pneumothorax
C. Iatrogenic pneumothorax
Rationale: Iatrogenic pneumothorax occurs as a result of medical procedures, such as subclavian catheter insertion, which can inadvertently puncture or lacerate the lung.
A patient undergoing mechanical ventilation is at increased risk for which of the following types of pneumothorax?
A. Spontaneous pneumothorax
B. Iatrogenic pneumothorax
C. Traumatic pneumothorax
D. Tension pneumothorax
B. Iatrogenic pneumothorax
Rationale: Iatrogenic pneumothorax can result from barotrauma due to excessive ventilatory pressures during mechanical ventilation, causing alveolar rupture and subsequent pneumothorax.
A nurse is monitoring a patient who is undergoing a transthoracic needle aspiration. Which of the following is the nurse’s priority action if a pneumothorax is suspected?
A. Administer pain medication
B. Notify the healthcare provider immediately
C. Apply oxygen via a non-rebreather mask
D. Prepare for chest tube insertion
B. Notify the healthcare provider immediately
Rationale: If a pneumothorax is suspected during or after a transthoracic needle aspiration, it is critical to notify the healthcare provider immediately for further evaluation and possible intervention.
A patient who recently underwent a pleural biopsy develops a pneumothorax. Which of the following is the most common cause of iatrogenic pneumothorax in this patient?
A. Laceration of the lung during the biopsy
B. Excessive ventilatory pressures used during the procedure
C. Air entering the pleural space from a tear in the esophagus
D. Infection from the biopsy causing alveolar rupture
A. Laceration of the lung during the biopsy
Rationale: Pleural biopsy can result in iatrogenic pneumothorax if the lung is accidentally lacerated or punctured during the procedure.
A patient with a history of esophageal surgery is at risk for iatrogenic pneumothorax due to which of the following scenarios?
A. Tearing of the esophageal wall during gastric tube insertion
B. Excessive ventilatory pressure during anesthesia
C. Trauma during chest tube insertion
D. Barotrauma from mechanical ventilation
A. Tearing of the esophageal wall during gastric tube insertion
Rationale: Iatrogenic pneumothorax can occur when the esophageal wall is torn during gastric tube insertion, allowing air to enter the mediastinum and pleural space.
A nurse is caring for a patient with a tension pneumothorax. Which of the following is the priority intervention for this condition?
A. Administer oxygen therapy
B. Start an intravenous line to administer fluids
C. Perform needle decompression to relieve pressure
D. Insert a chest tube to drain the pleural space
C. Perform needle decompression to relieve pressure
Rationale: Tension pneumothorax is a medical emergency requiring immediate intervention to relieve the pressure in the pleural space. Needle decompression is the first priority to restore pressure balance and prevent cardiovascular collapse.
A patient with a tension pneumothorax is exhibiting signs of tracheal deviation and severe respiratory distress. The nurse understands that this is due to:
A. Increased venous return from the unaffected side
B. Pressure on the heart and great vessels from the trapped air
C. Decreased pressure on the unaffected lung
D. Rapid oxygenation of the affected lung
B. Pressure on the heart and great vessels from the trapped air
Rationale: In a tension pneumothorax, air enters the pleural space but cannot escape, causing pressure to build up. This pressure compresses the heart and great vessels, causing the mediastinum to shift and affecting both cardiac and respiratory function.
A nurse is assessing a patient with suspected tension pneumothorax. Which of the following signs is the most concerning and requires immediate intervention?
A. Increased neck vein distention
B. Decreased breath sounds on the affected side
C. Severe dyspnea and marked tachycardia
D. Tracheal deviation to the unaffected side
D. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation is a late sign of tension pneumothorax and indicates severe pressure in the pleural space. Immediate intervention is necessary to relieve the pressure and prevent further complications.
A nurse is caring for a patient who sustained a trauma and is at risk for developing a tension pneumothorax. Which of the following actions may cause or exacerbate tension pneumothorax in this patient?
A. Clamping a chest tube in place
B. Administering high-flow oxygen
C. Inserting a nasogastric tube
D. Elevating the head of the bed
A. Clamping a chest tube in place
Rationale: Clamping a chest tube can obstruct the pleural drainage, leading to the accumulation of air and causing or exacerbating a tension pneumothorax, which can result in increased pressure and cardiovascular compromise.
A patient with a tension pneumothorax is being prepared for needle decompression. The nurse prepares to insert the needle in which location?
A. Above the fifth intercostal space, midaxillary line
B. Below the seventh rib, anterior axillary line
C. Second intercostal space, midclavicular line
D. Fifth intercostal space, anterior axillary line
C. Second intercostal space, midclavicular line
Rationale: The appropriate location for needle decompression in a tension pneumothorax is the second intercostal space, midclavicular line, on the affected side. This allows for effective release of pressure in the pleural space.
A nurse is monitoring a patient after successful needle decompression for tension pneumothorax. Which of the following findings would indicate that the patient is stabilizing?
A. Decreased neck vein distention
B. Tracheal deviation to the affected side
C. Increased breath sounds on the affected side
D. Decreased tachycardia and improved oxygenation
D. Decreased tachycardia and improved oxygenation
Rationale: After needle decompression, the reduction in intrapleural pressure should improve the patient’s oxygenation and decrease tachycardia, indicating that cardiovascular and respiratory function is stabilizing.