An X-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patients plan of care?

Correct Answer: A

Rationale: A small flail chest injury, where a segment of ribs is fractured in multiple places, disrupts chest wall stability but, if minor, is managed supportively. Suctioning airway secretions is critical because pain from rib movement discourages coughing, leading to mucus retention and potential atelectasis or pneumonia. This intervention clears the airway, supports ventilation, and prevents complications, aligning with the goal of maintaining respiratory function. Immobilizing ribs with a binder restricts breathing, worsening oxygenation, and is contraindicated. Surgery is rare and reserved for severe cases with large flail segments or internal damage. Immediate sedation and intubation are unnecessary for a small injury unless respiratory failure ensues, which isn't indicated here. The nurse's focus on secretion clearance via suctioning, alongside pain control and breathing exercises, optimizes recovery in this trauma patient.

Correct Answer: D

Rationale: Post-embolectomy for pulmonary embolus (PE), the nurse most closely monitors pulmonary arterial pressure (PAP) via a pulmonary artery catheter, as it directly reflects the procedure's success in relieving pulmonary vascular obstruction. Elevated PAP pre-surgery indicates blockage; post-surgery, a decrease signals clot removal efficacy, while persistent elevation suggests residual emboli or reperfusion issues, guiding further intervention (e.g., thrombolytics). Pupillary response assesses neurological status, irrelevant unless cerebral hypoxia occurred. Vena cava pressure isn't routinely monitored and lacks specificity for PE outcomes. White blood cell differential tracks infection or inflammation, not acute hemodynamic status. PAP monitoring, alongside urinary output for perfusion, equips the nurse to detect complications (e.g., re-embolization), ensuring optimal postoperative management in this critical ICU patient.

Correct Answer: C

Rationale: Bilateral wheezes are the assessment finding most closely tied to asthma's characteristic symptoms cough, dyspnea, and wheezing reflecting airflow obstruction from bronchospasm, inflammation, and mucus. Wheezing, a high-pitched sound on expiration (and sometimes inspiration), arises as air squeezes through narrowed airways, a hallmark audible in both lungs during an attack. Shallow respirations occur but aren't specific, lacking the obstructive quality of wheezes. Increased A-P diameter (barrel chest) develops in chronic COPD, not typically in pediatric asthma unless severe and longstanding. Bradypnea, slow breathing, contradicts asthma's tachypnea from air hunger. The nurse's detection of bilateral wheezes confirmed by auscultation guides acute management (e.g., bronchodilators), aligning with asthma's reversible, inflammatory pathophysiology in this child.

Correct Answer: B

Rationale: Bronchospasm in COPD, a sudden airway narrowing from smooth muscle contraction, is suggested by wheezes or diminished breath sounds on auscultation. Wheezing a high-pitched sound from turbulent airflow through constricted passages is classic, while diminished sounds reflect reduced air entry, both audible in acute exacerbation. Crackles (fine or coarse) indicate fluid or mucus, typical in pneumonia or heart failure, not bronchospasm's dry obstruction. Reduced respiratory rate or lethargy suggests severe hypoxia or fatigue, not specific to bronchospasm COPD patients often show tachypnea. Slow, deliberate respirations may be compensatory but aren't diagnostic. The nurse's detection of wheezes or diminished sounds confirmed by stethoscope prompts bronchodilator use, aligning with COPD exacerbation management to reverse this reversible component.

Correct Answer: B

Rationale: Reviewing laboratory tests and allergies occurs in the preoperative phase, before surgery begins, to establish a baseline and identify risks like drug reactions or abnormal clotting. This preparation ensures the surgical team can tailor anesthesia and interventions, reducing complications. Perioperative spans all phases pre, intra, and post but isn't specific to this task. Intraoperative care happens during surgery in the operating suite, focusing on the procedure, not initial assessments. Postoperative care, in settings like the PACU, monitors recovery, not pre-surgery data. By completing this in the preoperative phase, the nurse mitigates physiological risks, such as bleeding from unrecognized coagulopathy or anaphylaxis from allergens, aligning with safety protocols to optimize surgical success and patient stability throughout the process.