In a patient with a massive flail chest, all of the following factors are indications for ventilatory support except:

• Hypercapnia, hypoxia, and dyspnea
• Progressive breathing fatigue
• Imminent abdominal surgery
• Advanced age and obesity

When assessing a patient with acute respiratory failure resulting from impaired ventilation, the nurse would initially expect to note:

• Hypercapnia
• Hypocapnia
• Hypoxia
• Hypoxia and hypercapnia

A 25-year-old man drives to the ED after falling off a roof and landing on his right side on a concrete abutment. His chief complaints are dyspnea and significant chest pain. All of the following nursing actions would ensure proper ventilation and perfusion in this patient except:

• Encouraging slow, deep breathing
• Positioning the patient on his right side
• Positioning the patient on his left side
• Splinting the affected side with a pillow

In a patient with atelectasis, the nurse would expect to hear bronchial breath sounds over the:

• Carina
• Middle of the right lung lobe
• Right main-stem bronchus
• Left main-stem bronchus

The nurse assesses a patient at risk for respiratory failure. All of the following are early signs of respiratory failure except:

• Restlessness
• Tachycardia
• Cyanosis
• Tachypnea

In a patient with multiple rib fractures, which nursing intervention would be appropriate to encourage optimal ventilation?

• Frequently administering low-dose narcotics, as ordered
• Performing postural drainage and incentive spirometry
• Encouraging forceful coughing after chest percussion
• Binding the chest wall

Which is the most common cause of impaired gas exchange after blunt chest trauma?

• Flail chest
• Phrenic nerve paralysis
• Pulmonary contusion
• Apnea or hypopnea

The nurse knows that flail chest is easiest to assess:

• When the thoracic fracture occurs posteriorly
• Immediately after the injury
• In a conscious patient with well-developed musculature
• When the thoracic fracture occurs anteriorly

Fracture of the scapula or first or second rib indicates a serious force of injury and a high probability of underlying tissue damage. The nurse knows that, in the emergent phase of care, pulmonary contusion is best indicated by:

• Dyspnea assessment
• Arterial blood gas analysis
• Auscultation
• Radiographic studies

Which injury constitutes flail chest?

• Fractured xiphoid process
• Single fractures of the seventh and eighth left and right anterior ribs
• Single fractures of the fourth, fifth, sixth, and seventh left lateral ribs
• Fractured sternum