The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the clients oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?

Correct Answer: A

Rationale: A pneumothorax, a collapsed lung from air in the pleural space, disrupts normal lung expansion, leading to distinct assessment findings. Diminished or absent breath sounds on the affected side occur because air cannot enter the collapsed lung segment, reducing or eliminating audible airflow during auscultation. This is a classic sign, especially post-procedure like central line insertion, which risks pleural puncture. Paradoxical chest wall movement is specific to flail chest, where multiple rib fractures cause a segment to move oppositely during breathing, not a simple pneumothorax. Sudden loss of consciousness might indicate severe hypoxia or tension pneumothorax but isn't a primary sign. Muffled heart sounds suggest pericardial tamponade, a cardiac issue unrelated to pneumothorax. The nurse's observation of respiratory distress and absent breath sounds strongly supports pneumothorax, warranting immediate intervention like chest tube insertion.

Correct Answer: D

Rationale: Small cell lung cancer (SCLC) is rarely treated with surgery because it grows rapidly and metastasizes early and extensively, often presenting with distant spread (e.g., brain, bones) by diagnosis. Unlike non-small cell lung cancer (NSCLC), where surgery suits localized disease, SCLC's aggressive neuroendocrine nature drives early dissemination, rendering resection ineffective as a primary cure. Cell size doesn't limit visualization surgical feasibility hinges on containment, not microscopy. SCLC isn't self-limiting; it's fatal without treatment, progressing quickly, not delaying intervention. Patient stability varies, but surgery's exclusion stems from tumor behavior, not universal frailty. The nurse's response, rooted in SCLC's biology, clarifies why chemotherapy and radiation systemic therapies are standard, aligning with guidelines (e.g., NCCN) and helping the patient understand his treatment plan.

Correct Answer: C

Rationale: Bronchiectasis involves chronic, irreversible dilation of bronchi and bronchioles from repeated inflammation or infection, destroying muscle and elastic tissue. This widening traps mucus, fostering recurrent infections and obstruction, leading to respiratory difficulties like chronic cough and dyspnea. Acute bronchospasm, tightening of airways, is asthma's hallmark, not bronchiectasis's structural damage. Alveolar distention and impaired diffusion occur in emphysema, affecting gas exchange at the alveolar level, not bronchial dilation. Excessive gas exchange isn't a feature bronchiectasis reduces effective ventilation. The student nurse's recognition of this pathophysiology confirmed by imaging (e.g., CT showing bronchial widening) prepares them to anticipate copious sputum and infection risk, guiding care like chest physiotherapy to manage this distinct airway disease.

Correct Answer: B

Rationale: Severe arthritis in the hands precludes safe, effective metered-dose inhaler (MDI) use in a COPD patient, as it impairs the dexterity needed to press the canister and coordinate inhalation critical for drug delivery to the lungs. Poor technique reduces efficacy of bronchodilators or corticosteroids, worsening dyspnea. Ongoing smoking doesn't affect MDI mechanics, though it harms prognosis. Requiring both corticosteroids and beta2-agonists is common in COPD, manageable with separate or combined MDIs, not precluding use. Cataracts impair vision but not hand function; spacers can aid if technique falters. The nurse's recognition of arthritis prompts alternatives (e.g., nebulizers), ensuring medication delivery despite physical limitations, per COPD device selection principles.

Correct Answer: B

Rationale: A peak flow meter measures the highest airflow during a forced expiration, known as peak expiratory flow rate (PEFR), in liters per minute. This handheld device assesses airway obstruction in asthma patients exhale maximally after a deep breath, gauging how fast air exits narrowed passages. Lower readings signal worsening bronchospasm or inflammation, guiding therapy (e.g., rescue inhaler use) via personal best zones (green, yellow, red). Forced inspiration isn't measured inhalation isn't limited in asthma. Normal inspiration or expiration reflects tidal breathing, not obstruction severity. The educator's teaching demonstrating technique (e.g., standing, full effort) ensures the patient tracks lung function daily, aligning with asthma self-monitoring to prevent exacerbations effectively.