NR-324 Adult Health I - Set 2 - Part 3

Correct Answer: A spontaneous left-sided pneumothorax from a ruptured bleb

Unilateral absent breath sounds with hyperresonance over the same side indicates air in the pleural space. The tall, thin young adult at rest fits the classic primary spontaneous pneumothorax caused by a ruptured surface bleb. Option a is incorrect because fluid in the pleural space produces a dull percussion note, not a hyperresonant one. Effusions also build gradually and rarely announce themselves this abruptly in a healthy young adult. Option c is incorrect because consolidated lung transmits sound and yields crackles with dullness rather than silence and hyperresonance. An infectious process also develops over days with fever, not instantly during quiet rest. Option d is incorrect because blood occupying the pleural space percusses dull, and the history contains no injury. Hemothorax is expected after penetrating wounds, rib fractures or thoracic surgery rather than spontaneously.

Correct Answer: Start controlled oxygen titrated to eighty-eight to ninety-two percent

The client is hypoxemic and needs oxygen, but a high concentration risks worsened mismatch and carbon dioxide retention. Controlled oxygen titrated into the eighty-eight to ninety-two percent range treats hypoxemia while limiting that hazard. Option a is incorrect because leaving a client at eighty-four percent while laboratory results are awaited is never acceptable. Hypoxia kills within minutes, while carbon dioxide retention develops over hours and can be corrected. Option b is incorrect because a reservoir mask floods this client with far more oxygen than the target requires and belongs to shock, trauma or arrest. An uncomplicated exacerbation begins with a controlled device. Option c is incorrect because breathing technique alone cannot lift a saturation of eighty-four percent, and ten minutes of watching wastes time the client does not have. Coaching supports oxygen rather than replacing it.

Correct Answer: Ventilation, the mechanical movement of air

Shallow breathing at six per minute with opioid sedation is a mechanical failure to move air. Ventilation is measured by carbon dioxide level, so this client's arterial carbon dioxide is rising while oxygen falls. Option b is incorrect because the alveolar capillary membrane in this client is intact and able to exchange gas normally. Nothing has damaged the lung tissue itself; too little air is simply reaching the alveoli. Option c is incorrect because cardiac output and blood flow through the lungs are unaffected by opioid sedation. Perfusion problems show up as hypotension, weak pulses and delayed capillary refill, none of which are described. Option d is incorrect because oxygen delivered to the tissues is still being taken up by cells that use it normally. Cellular uptake fails in poisonings such as cyanide, which this scenario does not suggest.

Correct Answer: The saturation cannot rule out carbon dioxide retention

Pulse oximetry reports saturated hemoglobin only, and supplemental oxygen can hold that number normal while carbon dioxide climbs from shallow breathing. A normal saturation never excludes ventilatory failure, so a blood gas is needed. Option a is incorrect because the number describes oxygen carriage and says nothing about air movement. A rate of eight with shallow depth is inadequate ventilation whatever the oximeter displays. Option b is incorrect because poor perfusion drives readings down or makes them disappear entirely, not up. Nothing in this scenario describes cold extremities, hypotension or a weak signal at the probe. Option d is incorrect because dismissing drowsiness as normal recovery overlooks opioid induced hypoventilation, a common and reversible cause after surgery. Sedation plus a low rate is a warning pattern, not a routine one.

Correct Answer: About twenty-eight percent of inspired oxygen

A nasal cannula raises the inspired concentration roughly four percent for each liter above the twenty-one percent of room air, so two liters gives about twenty-eight percent to this client. Option a is incorrect because that figure describes breathing no supplemental oxygen at all. Adding flow through the prongs fills the nasopharynx with oxygen and lifts the concentration above the room air value. Option c is incorrect because that range belongs to a mask with a reservoir bag running at high flow. No cannula setting reaches it, and even six liters delivers only about forty-four percent. Option d is incorrect because only a tightly sealed bag valve device approaches that concentration. Prongs sit in the nares while the client also draws in a large volume of room air with every breath.

Correct Answer: Document the finding and continue routine monitoring

Gentle continuous bubbling in the suction control chamber shows that suction is being delivered at the prescribed level. This is an expected finding in a wet system and requires only documentation and ongoing monitoring. Option a is incorrect because turning the suction down until bubbling ceases would stop the prescribed suction from reaching the client. The wall setting is reduced only when the bubbling is vigorous and noisy. Option b is incorrect because an air leak is signaled by continuous bubbling in the water-seal chamber, not this one. The chamber name rather than the word continuous identifies which finding is abnormal. Option c is incorrect because clamping is reserved for brief, specific purposes and has no role when the system is working normally. Interrupting the only exit for pleural air risks a tension pneumothorax.

Correct Answer: Turn the wall suction down to produce gentle bubbling

Vigorous noisy bubbling means the wall regulator is set too high. Because the water column height, not the wall setting, determines the suction reaching the client, lowering the regulator costs the client nothing and stops the water loss. Option b is incorrect because an air leak is identified by continuous bubbling in the water-seal chamber. Bubbling in the suction control chamber reflects only the wall regulator setting and carries no such meaning. Option c is incorrect because nothing here warrants occluding tubing or exchanging the unit. The system is functioning, and the single correction needed is a turn of the dial on the wall regulator. Option d is incorrect because refilling without reducing the regulator leaves the cause untouched, and the water will evaporate again. Restoring the column matters, but only after the excessive wall suction is lowered.

Correct Answer: Continue all daily control medicines

Readings of eighty to one hundred percent of personal best are the green zone, meaning good control. The client keeps taking every long term controller and may use quick relief medicine before exercise. Option a is incorrect because an oral steroid burst belongs to the yellow zone that persists or to the red zone. Starting one during good control exposes the client to steroid effects with nothing to gain. Option c is incorrect because contacting the provider urgently is reserved for readings under half of personal best or for symptoms that persist after quick relief. Stable green zone numbers need only routine follow up. Option d is incorrect because a controller works only while it is taken daily, whether or not the client feels well. Stopping it lets airway inflammation rebuild silently until the next exacerbation arrives.

Correct Answer: Apply a reservoir mask at fifteen liters

In shock, trauma and peri-arrest every client starts on a reservoir mask at high flow, whatever the hypercapnic risk. The controlled target is applied later, once there is a circulation to titrate against. Option a is incorrect because a twenty-eight percent device is the controlled choice for an uncomplicated exacerbation, not for a shocked trauma client whose tissues need the highest concentration available right now. Option b is incorrect because two liters cannot meet the demand of a client in shock with failing perfusion. Low flow settings belong to stable clients, and this one is close to arrest. Option c is incorrect because an absent reading reflects collapsed peripheral flow, not adequate oxygenation, and treatment cannot wait for a number. Withholding oxygen from a shocked client is never the safe choice.

Correct Answer: Expiratory wheezing with prolonged expiration

Obstruction attacks exhalation because exhalation depends on elastic recoil and on airways held open. Air forced through narrowed airways oscillates their walls, producing expiratory wheeze, and emptying takes longer, so the expiratory phase lengthens. Option a is incorrect because airflow limitation lengthens exhalation rather than shortening it, and breathing is noisy with wheeze rather than quiet. A shortened quiet expiratory phase would suggest normal airway caliber, which asthma does not produce. Option b is incorrect because stridor is a harsh inspiratory sound arising from upper airway narrowing such as croup, epiglottitis or a foreign body. Asthma narrows the lower airways, so the sound generated is a wheeze. Option d is incorrect because dullness signals fluid or consolidation, as in pneumonia or pleural effusion. Trapped air in asthma makes the chest hyperresonant instead, since hyperinflated lung holds more air than normal tissue.