NURS 239 Exam 3 (100% accurate)

An emergency room nurse is assessing a client who sustained a blunt injury to the chest wall. Which of these signs and symptoms would you not find in this client? correct answers closed or foiled chest The nurse is assessing the client with fractures of the ribs, 4,5, and 6 on the left side. Assessment includes, respiratory 8 and shallow, lungs clear with decreased breath sounds left side, pain level 9/10, PaO2 84, PaCO2 46 and 7.33 pH, and paradoxical chest wall movement noted. The nurse understands that the most important interventions for this client include correct answers Use splinting, positioning, coughing, and deep breathing to frequently assist in lung expansion When providing preoperative teaching to the client undergoing a pneumonectomy via a large lateral thoracotomy it is most important for the nurse to instruct the client correct answers -use of sequential compression devices -potential of chest tube system after surgery -frequent turning, coughing and deep breathing An auto accident victim admitted to the hospital develops a tension pneumothorax on the right side, the nurse expects to assess which of the following objective data? correct answers -tension pneumothorax -hypotension -tracheal deviation to the left -paradoxical chest wall movement A client has suffered a flailed chest as paradoxical chest wall movements. The nurse knows this means when the client correct answers -inspires the chest wall pulls in -expires the chest wall pushes out A nurse in the post anesthesia care unit is caring for a client who is post operative following a thoracotomy and lobectomy. Which of the following post operative assessments should the nurse give the highest priority? correct answers -arterial blood gases A 40 year old post-operative client has a hemoglobin level of 8, SpO2 of 95%, considering all aspects, the nurse concludes that the client has a potential risk for correct answers -potential risk for hypoxia . A client recovering from thoracic surgery is demonstrating evidence of impaired gas exchange with a slight drop oxygen saturation level. Which of the following nursing interventions would be appropriate for the client at this time? correct answers -educate the use of the use of incentive spirometer -Turn every 2 hours -splint chest wall when coughing -suction as necessary