Medical Surgical Nursing Practice Questions Related

Review Medical Surgical Nursing Practice Questions related questions and content

A nurse in the PACU is assessing a client who has an endotracheal tube (ET) in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

  • A. Blockage of the ET tube by the client's tongue
  • B. Passage of the ET tube into the esophagus
  • C. Movement of the ET tube into the right main bronchus
  • D. Infection of the vocal cords
Correct Answer: C

Rationale: The correct answer is C: Movement of the ET tube into the right main bronchus. When the nurse observes absence of left-sided chest wall expansion, it indicates that the ET tube may have moved into the right main bronchus. This can lead to inadequate ventilation of the left lung, causing unilateral chest wall expansion. The other choices are incorrect because: A) Blockage by the tongue would not result in unilateral chest wall expansion. B) Passage into the esophagus would lead to improper ventilation but not specifically affect one side of the chest. D) Infection of the vocal cords would not directly cause unilateral chest wall expansion.