Chapter 32: Chest Trauma AQ EX3

The nurse is caring for a patient who was physically assaulted. The patient has severe pain upon movement and splints the chest defensively. How is this patient's injury managed? 1 Administer an intercostal nerve block. 2 Administer antibiotics and fluid therapy. 3 Place an immediate needle thoracostomy followed by a chest tube. 4 Provide oxygen and intravenous (IV) fluids, and place patient in a moderate-Fowler position.

Administer an intercostal nerve block.

Which treatment modality is the focus during the management of an uncomplicated rib fracture? 1 Splinting the chest 2 Administering analgesics 3 Stabilizing the chest surgically 4 Applying positive pressure ventilation

Administering analgesics

Which procedure would be beneficial in confirming a hemothorax in a patient who suffered blunt chest trauma? 1 Palpation 2 Percussion 3 Chest x-ray 4 Auscultation

Chest x-ray

Which statements are true regarding the management of patients with a hemothorax? Select all that apply.

Close monitoring of chest tube drainage is needed. Blood lost through the chest drainage system can be infused back.

While doing a physical assessment of a patient with chest trauma, which findings would lead the nurse to suspect the patient has a tension pneumothorax? Select all that apply. 1 Stridor 2 Cyanosis 3 Distended neck veins 4 Paradoxical chest movements 5 Hypertympanic sounds on percussion

Cyanosis Distended neck veins Hypertympanic sounds on percussion

Which finding supports the nurse's diagnosis that a patient on chest tube drainage shows signs of tension pneumothorax? 1 Tachycardia and hypotension 2 Cyanosis and distended neck veins 3 Massive air leaks from tracheal lacerations 4 Reduced breath sounds on auscultation and hyperresonance on percussion

Cyanosis and distended neck veins

What term describes bleeding into the chest cavity?

Hemothorax

Which condition may require the use of a combination of multiple chest tubes and serial radiography monitoring as a treatment modality? 1 Flail chest 2 Hemothorax 3 Pneumothorax

Hemothorax

Which type of chest trauma produces a dull sound on percussion of the affected side?

Hemothorax

The first emergency approach to all chest injuries is "ABC." What is the first part of this approach?

Airway

Which assessment finding is commonly seen in a patient with a tension pneumothorax?

Hyperresonance on percussion

Which is associated with "paradoxical chest wall movement"? 1 Bilateral separation of the ribs from their cartilage 2 Deviation of the trachea away from the side of the injury 3 Forceful entry of air into the chest cavity causing collapse of the affected lung 4 Inward movement of the thorax during inspiration with an outward movement during expiration

Inward movement of the thorax during inspiration with an outward movement during expiration

Which Fowler's position is ideally recommended for a patient with pulmonary contusion?

Moderate Fowler's

What can the nurse anticipate will be the initial management for a tension pneumothorax? 1 Humidified oxygen 2 Needle thoracostomy 3 Splinting of the chest 4 Chest tube placement

Needle thoracostomy

A patient on mechanical ventilation has a sudden onset of respiratory distress. The nurse auscultates absent breath sounds on the right side and observes a shift of the trachea to the left. The patient is cyanotic and has distended neck veins. Which is the priority action the nurse should take?

Notify the Rapid Response Team.

Which treatment strategy would be most beneficial to the patient with a hemothorax who has severe blood loss from the chest? 1 Tracheotomy 2 Open thoracotomy 3 Cricothyroidotomy 4 Needle thoracostomy

Open thoracotomy

The nurse reviews the results of the computed tomography (CT) assessment of a patient with chest trauma. Which diagnosis does the nurse anticipate if the CT scan reveals fractures of two neighboring ribs in three planes? 1 Flail chest 2 Pulmonary contusion 3 Tension pneumothorax 4 Tracheobronchial trauma

Flail chest

What is the sequence of events related to tension pneumothorax in their order of occurrence? 1. Limiting of blood return 2. Compressing the blood vessels 3. Decreasing the cardiac filling and cardiac output 4. Forcing air into the chest cavity and increasing the pressure

-Forcing air into the chest cavity and increasing the pressure -Compressing the blood vessels -Limiting of blood return -Decreasing the cardiac filling and cardiac output

What is the priority nursing intervention for a patient with chest trauma that is suspected of having a pneumothorax?

Preparing for a chest tube insertion

Which statement by a student nurse about assessment findings for a patient with pneumothorax indicates a need for further teaching?

"Hyporesonance is noted on percussion."

Place in the correct order the physiological changes occurring in a patient with pulmonary contusion.

- Hemorrhage and edema occur in and between the alveoli first, thereby reducing both lung movement and the area available for gas exchange. - The patient will then experience hypoxia and dyspnea. - Hazy opacity in the lobes or lung parenchyma can develop over time.

Which value of the expiratory volume signifies a poor prognosis in patients with deep chest trauma? 1 10 mL/kg 2 15 mL/kg 3 20 mL/kg 4 25 mL/kg

10 mL/kg

Which finding in a computed tomography (CT) report of a patient with chest trauma indicates flail chest?

Bilateral separation of the ribs from the cartilage connections

Which abnormality would the nurse assess for a patient diagnosed with flail chest? Select all that apply. 1 Dyspnea 2 Bradycardia 3 Hypotension 4 Deviated trachea 5 Paradoxical chest movement

Dyspnea Hypotension Paradoxical chest movement

Which findings support the nurse's suspicion that a patient with rib fractures has a flail chest? Select all that apply.

Dyspnea Hypotension Paradoxical chest movement

The nurse is caring for a patient injured in a high-speed car crash. The patient is cyanotic, hypotensive, anxious, short of breath, and in pain. How is this patient's injury managed? Select all that apply.

Deep breathing Tracheal suction Pain management Humidified oxygen

Which assessment findings indicate that a patient with pleuritic pain, tachypnea, and subcutaneous emphysema has pneumothorax? 1 Dull percussion notes 2 Paradoxical chest movement 3 Increased breath sounds on auscultation 4 Deviated trachea away from the side of injury

Deviated trachea away from the side of injury

Which statement is true about a patient with flail chest? 1 Patients with lung contusion should be restricted from intravenous fluids. 2 Patients with severe hypoxemia are treated with humidified oxygen. 3 Patients with flail chest are primarily treated by surgical stabilization. 4 Patients with flail chest are stabilized by using positive-pressure ventilation.

Patients with flail chest are stabilized by using positive-pressure ventilation.

A patient with chronic obstructive pulmonary disease (COPD) reports acute difficulty breathing and right-side pleuritic pain. Auscultation reveals decreased breath sounds in the right lung field compared to the left lung field. Which possible condition does the nurse contact the provider for based on these assessment data?

Pneumothorax

In which condition does the primary health care provider advocate the use of a single chest tube in a patient with chest trauma?

Pneumothorax

What term describes air in the pleural space?

Pneumothorax

The nurse is caring for a patient injured in a car crash. The patient has bruising in the chest area, dry cough, and decreased breath sounds. The chest x-ray shows no abnormalities. How is this patient's injury managed?

Provide oxygen and intravenous (IV) fluids, and place patient in a moderate-Fowler position.

Which type of trauma indicates splinting of the chest as the treatment modality? 1 Flail chest 2 Rib fracture 3 Pneumothorax 4 Tension pneumothorax

Rib fracture

The nurse, while assessing a patient who just underwent a central venous access catheter insertion, notices cyanosis and absence of breath sounds on the same side. What complication should the nurse suspect?

Tension pneumothorax

Which complication should the nurse suspect if, while mechanically ventilating a patient with positive end-expiratory pressure (PEEP), the patient suddenly experiences extreme respiratory distress? 1 Flail chest 2 Hemothorax 3 Pneumothorax 4 Tension pneumothorax

Tension pneumothorax

Which condition may manifest in a patient with a completely collapsed lung due to entry of air into the chest cavity?

Tension pneumothorax

Which type of chest trauma produces a hyperresonance sound on percussion of the affected area?

Tension pneumothorax