Which of the following statements best describes tension pneumothorax?

Correct Answer: A

Rationale: In the context of oxygenation and respiratory care in nursing practice, understanding tension pneumothorax is crucial for providing effective and timely interventions. The correct answer, option A, is the most accurate description of tension pneumothorax. This condition occurs when air enters the pleural space, typically due to lung trauma or injury, but cannot exit, leading to a build-up of pressure that collapses the affected lung. Option B is incorrect because it conflates tension pneumothorax with general pneumothorax, which can result from various causes beyond just chest or respiratory structure injuries. Option C is also inaccurate as it describes spontaneous pneumothorax caused by bleb rupture, not tension pneumothorax specifically. Educationally, nurses must grasp the distinction between different types of pneumothorax to provide appropriate care. Recognizing tension pneumothorax is crucial as it is a life-threatening emergency requiring prompt intervention to prevent respiratory compromise and cardiovascular collapse. Nurses must be able to identify signs and symptoms, such as sudden onset dyspnea and hypotension, and understand the importance of immediate decompression to release trapped air and alleviate pressure on the affected lung.

Correct Answer: A

Rationale: The correct answer is A) ACVCV (Assist-Control Volume Control Ventilation) because this mode of ventilation is designed to deliver a set tidal volume with consistent flow patterns, which would match the pressure, flow, and volume waveform described in the question. In ACVCV, the ventilator delivers a preset tidal volume at a set flow rate regardless of the patient's efforts to breathe. This results in a consistent waveform pattern. Option B) ACPCV (Assist-Control Pressure Control Ventilation) would not be the correct choice because this mode delivers a set pressure, not volume, so the waveform described would not align with this mode of ventilation. Option C) AC PRVC (Assist-Control Pressure Regulated Volume Control) is also an incorrect choice because in this mode, the ventilator adjusts the pressure to achieve a target tidal volume, which would result in a different waveform pattern compared to the one described in the question. Option D) PSV (Pressure Support Ventilation) is not the correct answer because in this mode, the patient initiates the breath and the ventilator provides support to maintain a certain pressure level during inspiration. This mode would not produce the specific waveform pattern described in the question. Understanding different modes of ventilation is crucial for nurses to effectively manage patients requiring mechanical ventilation. By analyzing waveforms and understanding the principles behind each ventilation mode, nurses can optimize patient care and make informed decisions to ensure proper oxygenation and ventilation.

Correct Answer: D

Rationale: The correct answer is D) 3% NaCl solution for aerosolized sputum induction in a spontaneously breathing, non-intubated patient. 3% hypertonic saline is effective because it has a higher osmolarity compared to normal body fluids, drawing water into the airway surface liquid. This hydrates the secretions, making them less viscous and easier to mobilize through coughing or suctioning. Option A) Sterile, distilled water is hypotonic and may lead to further dehydration of the airway surface, making secretion mobilization more difficult. Option B) 0.45% NaCl solution is isotonic and may not provide enough osmotic force to effectively hydrate and mobilize secretions. Option C) 0.9% NaCl solution is also isotonic and may not be as effective as 3% hypertonic saline in promoting sputum induction. In the context of nursing practice, understanding the rationale behind using 3% hypertonic saline for sputum induction is crucial for providing evidence-based care to patients with respiratory conditions like cystic fibrosis or chronic obstructive pulmonary disease. Nurses need to be knowledgeable about the properties of different solutions to select the most appropriate one for therapeutic interventions aimed at improving oxygenation and airway clearance in patients.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Pneumothorax. When percussing a patient's chest during an assessment and noting increased resonance over the Right Upper Lobe (RUL), it indicates hyperresonance which suggests air trapping. In the case of a pneumothorax, air escapes into the pleural space leading to increased resonance on percussion due to the presence of air rather than lung tissue. Incorrect options: B) Consolidation typically presents with dullness on percussion due to the presence of fluid or solid material in the lung tissue, which dampens the sound. C) Pleural effusion results in dullness on percussion as well, as the fluid in the pleural space prevents sound transmission. D) Tumor would not cause increased resonance on percussion; it may lead to dullness if it affects the lung tissue or pleural space. Educational context: Understanding percussion findings is crucial in nursing assessments to differentiate between various respiratory conditions. Knowing the characteristic sounds associated with different pathologies helps nurses make accurate clinical judgments and provide appropriate care. Recognizing hyperresonance can prompt further evaluation for conditions like pneumothorax, guiding timely interventions and improving patient outcomes.

Correct Answer: B

Rationale: In the context of ECG interpretation, a wide QRS complex (>0.12 seconds) typically indicates an abnormality in the ventricular conduction system. Therefore, the correct answer is B) Ventricular tachycardia. Ventricular tachycardia is characterized by a wide QRS complex due to the abnormal, rapid electrical activity originating in the ventricles. Option A) Sinus rhythm is incorrect because sinus rhythm refers to the normal heartbeat originating from the sinoatrial node and is characterized by a narrow QRS complex. Option C) Normal sinus rhythm is also incorrect as it represents a regular, normal heartbeat with a narrow QRS complex. Option D) Supraventricular tachycardia is incorrect because it originates above the ventricles and typically presents with a narrow QRS complex. Understanding ECG findings is crucial in nursing practice, especially in assessing cardiac function and identifying arrhythmias promptly. Recognizing the significance of a wide QRS complex can aid nurses in providing appropriate interventions and collaborating effectively with the healthcare team to manage patients with cardiac rhythm abnormalities. This knowledge is vital in ensuring patient safety and optimizing outcomes in clinical practice.