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1. Question
The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client?
Correct
Answer: Option 2 is the correct answer.
Rationale: This client has sustained a blunt or closed-chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury. Test-Taking Strategy: Focus on the subject, a blunt chest injury. Noting the word blunt will assist in eliminating option 4, which describes a sucking chest wound injury. Knowing that in a respiratory injury increased respirations will occur will assist you in eliminating option 1. Option 3 can be eliminated because a barrel chest is a characteristic finding in a client with chronic obstructive pulmonary disease.
Incorrect
Answer: Option 2 is the correct answer.
Rationale: This client has sustained a blunt or closed-chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury. Test-Taking Strategy: Focus on the subject, a blunt chest injury. Noting the word blunt will assist in eliminating option 4, which describes a sucking chest wound injury. Knowing that in a respiratory injury increased respirations will occur will assist you in eliminating option 1. Option 3 can be eliminated because a barrel chest is a characteristic finding in a client with chronic obstructive pulmonary disease.
Pneumothorax
In pneumothorax, air or gas accumulates between the parietal and visceral pleurae, causing the lungs to collapse. The amount of air or gas trapped determines the degree of lung collapse. In some cases, venous return to the heart is impeded, causing a lifethreatening condition called tension pneumothorax.
Fractured rib lacerating lung. Paper bag effect. Spontaneously. Exertion. Coughing. Air travel. Positive pressure ventilation.
What causes it
Spontaneous pneumothorax can result from: • ruptured congenital blebs • ruptured emphysematous bullae • tubercular or malignant lesions that erode into the pleural space • interstitial lung disease such as eosinophilic granuloma. Traumatic pneumothorax can result from: • insertion of a central venous access device • thoracic surgery • thoracentesis or closed access device • penetrating chest injury • transbronchial biopsy.
