While caring for a client who was injured in a motor-vehicle crash and reports dyspnea and severe pain, a nurse in the emergency department notes that the client's chest moves inward during inspiration and bulges out during expiration. The nurse should identify this finding as which of the following?

Correct Answer: B

Rationale: The correct answer is B: Flail chest. Flail chest occurs when a segment of the rib cage is detached from the rest of the chest wall, causing paradoxical chest movement. In this case, the inward movement during inspiration and outward bulging during expiration are classic signs of flail chest, as the detached segment moves in the opposite direction of the rest of the chest wall. Atelectasis (choice A) refers to collapsed lung tissue, not paradoxical chest movement. Hemothorax (choice C) is the accumulation of blood in the pleural space, which does not cause paradoxical chest movement. Pneumothorax (choice D) is the presence of air in the pleural space, which can cause chest pain and dyspnea but does not result in paradoxical chest movement.

Correct Answer: A

Rationale: The correct answer is A: Provide the client with supplemental oxygen at 5 L/min via facemask. In cardiogenic pulmonary edema, the priority intervention is to improve oxygenation. Supplemental oxygen helps increase oxygen levels and alleviate respiratory distress, reducing the workload on the heart. This intervention addresses the client's dyspnea and anxiousness by improving oxygen delivery. Choice B is incorrect as placing the client in high-Fowler's position with legs in a dependent position can help with breathing but does not address the immediate need for oxygenation. Choice C is incorrect as sublingual nitroglycerin is typically used for angina and not the priority intervention for cardiogenic pulmonary edema. Choice D is incorrect as morphine sulfate IV may be indicated for pain relief and anxiety, but it is not the priority intervention to address the client's oxygenation needs in cardiogenic pulmonary edema.

Correct Answer: C

Rationale: The correct answer is C: Confirming the gag reflex. Immediately following a bronchoscopy, the nurse must prioritize confirming the gag reflex to ensure the client can protect their airway. This is crucial to prevent aspiration and respiratory complications. Observing for confusion (choice A) is important but not the priority in this situation. Auscultating breath sounds (choice B) is also important but confirming the gag reflex takes precedence. Measuring blood pressure (choice D) is not directly related to the immediate post-bronchoscopy monitoring.

Correct Answer: D

Rationale: The correct answer is D: Confusion. Confusion in an older adult with community-acquired pneumonia can indicate hypoxia or sepsis affecting the brain. It is a common manifestation in elderly patients with pneumonia due to impaired gas exchange and systemic inflammatory response. Unequal pupils do not typically relate to pneumonia. Hypertension is not a common finding in pneumonia; hypotension is more likely. Tympany upon chest percussion is associated with conditions like pneumothorax, not pneumonia. Therefore, confusion is the most relevant finding in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Avoid speaking for extended periods. This instruction is important to prevent strain on the vocal cords and reduce the risk of aspiration or airway irritation post-extubation. Speaking after the removal of the endotracheal tube can potentially lead to complications. Step-by-step rationale: 1. Speaking can cause strain on the vocal cords, which may lead to hoarseness or damage. 2. It is essential to allow the airway to recover and prevent irritation or inflammation. 3. Resting the voice can aid in the healing process and reduce the risk of complications. 4. Incentive spirometer use (option B) is important for lung expansion but not directly related to vocal cord rest. 5. Vital signs monitoring (option D) is crucial but does not address vocal cord care or prevention of complications. 6. Resting in a side-lying position (option A) is not directly related to vocal cord rest or post-extubation care.