CEN Thoracic: Questions & Solutions
After falling off a short ladder, a patient sustained fractures to the left fifth,
sixth, and seventh ribs. In addition to pain medication, what is the most
appropriate intervention to prevent atelectasis?
A. Prepare for fixation surgery.
B. Apply a rib belt.
C. Restrict fluid intake.
D. Promote coughing and deep breathing. Correct Ans - Good
pulmonary toilet (coughing and deep breathing, using incentive spirometry,
or both) can reduce the risk of atelectasis and pneumonia.
Rib belts are no longer used for rib fractures because they reduce the patient's
ability to cough and deep breathe.
Fluid restriction would be appropriate if the patient was suspected of having a
pulmonary contusion. However, promoting coughing and deep breathing is
the most appropriate intervention at this time.
A patient was stabbed in the chest during a bar fight. After chest radiography
reveals a hemothorax, a chest tube is inserted. Which finding indicates the
need for surgery?
A. Immediate drainage of 700 mL of blood
B. Blood return of 500 mL the second hour after chest tube insertion
C. Continuous bubbling in the underwater seal of the drainage system
D. Serosanguineous drainage of 100 mL the second hour after chest tube
insertion Correct Ans - Surgical intervention usually is indicated for an
immediate return of 1,000 to 1,500 mL of blood or continued blood loss that
exceeds 200 mL/hour.
Continuous bubbling in the water-seal chamber is expected until the lung had
re-expanded.
Four patients in the emergency department sustained thoracic injuries during
a rollover motor vehicle crash. They are all spontaneously breathing with at
least a minimally acceptable blood pressure. When triaging the patients,
which one takes the highest priority for emergency intervention?
A. A woman with paradoxical chest wall movement
,B. A man with a palpable sternal deformity
C. An adolescent with absent breath sounds on the right side and distended
neck veins
D. A geriatric man with extensive bruising of his chest wall Correct Ans -
Any patient with absent breath sounds on the side of injury, distended neck
veins, tracheal deviation, and hypotension is displaying signs of tension
pneumothorax.
This injury is immediately life threatening because it rapidly compromises
ventilation and circulation.
The patient requires chest tube insertion, emergency needle decompression,
or both.
signs of tension pneumothorax Correct Ans - absent breath sounds on
the side of injury,
distended neck veins,
tracheal deviation, and
hypotension
Why is a pneumothorax considered life threatening injury Correct Ans -
This injury is immediately life threatening because it rapidly compromises
ventilation and circulation.
pneumothorax Treatment: Correct Ans - The patient requires chest
tube insertion, emergency needle decompression, or both.
A patient with a gunshot wound is hemodynamically unstable and has cardiac
tamponade. This patient may benefit most from which treatment?
A. Chest tube insertion
B. Pericardiocentesis
C. Needle decompression
D. Emergency department thoracotomy Correct Ans -
Pericardiocentesis is a temporizing procedure used in the emergency
treatment for hemodynamically unstable patients with cardiac tamponade.
Blood withdrawal from the pericardial sac decreases the compression of the
myocardium and improves cardiac output.
What treatment is most appropriate for a patient with a flail chest?
, A. Perform needle thoracentesis and administer beta-blockers.
B. Provide pain relief and limit fluid intake.
C. Administer histamine (H2)-receptor antagonists and insert a nasogastric
tube.
D. Limit fluid intake and insert a nasogastric tube. Correct Ans - In a
patient with a flail chest, providing pain relief improves breathing
effectiveness. Limiting fluid intake avoids exacerbating the edema and
hemorrhage caused by the pulmonary contusions that usually occur in flail
chest.
Performing needle thoracentesis, administering beta-blockers or histamine
(H2)-receptor antagonists, and inserting a nasogastric tube are not
appropriate interventions for a patient with a flail chest.
A woman presents to the emergency department after being kicked in the
chest by a horse. Which signs and symptoms indicate that the patient is
experiencing cardiac tamponade?
A. Hypotension, muffled heart sounds, and distended neck veins
B. Absent or decreased breath sounds, tracheal deviation, and distended neck
veins
C. Hypertension in the upper extremities, decreased lower extremity pulses,
and intrascapular pain
D. Decreased breath sounds on the injured side, left shoulder pain, and bowel
sounds in the lower chest Correct Ans - Hypotension, muffled heart
sounds, and distended neck veins are a constellation of signs called Beck's
triad that are classic findings in cardiac tamponade. Absent or decreased
breath sounds, tracheal deviation, and distended neck veins suggest a tension
pneumothorax. Hypertension in the upper extremities, decreased lower
extremity pulses, and intrascapular pain are signs of aortic disruption.
Decreased breath sounds on the injured side, left shoulder pain, and bowel
sounds in the lower chest should lead you to suspect a diaphragmatic injury.
Which thoracic injury is associated with rib fractures, flail chest, and scapular
fractures?
A. Pulmonary contusion
B. Cardiac tamponade
C. Fracture of the larynx
D. Aortic disruption Correct Ans - Pulmonary contusions are
associated with rib fractures, flail chest, scapular fractures, hemothorax, and
After falling off a short ladder, a patient sustained fractures to the left fifth,
sixth, and seventh ribs. In addition to pain medication, what is the most
appropriate intervention to prevent atelectasis?
A. Prepare for fixation surgery.
B. Apply a rib belt.
C. Restrict fluid intake.
D. Promote coughing and deep breathing. Correct Ans - Good
pulmonary toilet (coughing and deep breathing, using incentive spirometry,
or both) can reduce the risk of atelectasis and pneumonia.
Rib belts are no longer used for rib fractures because they reduce the patient's
ability to cough and deep breathe.
Fluid restriction would be appropriate if the patient was suspected of having a
pulmonary contusion. However, promoting coughing and deep breathing is
the most appropriate intervention at this time.
A patient was stabbed in the chest during a bar fight. After chest radiography
reveals a hemothorax, a chest tube is inserted. Which finding indicates the
need for surgery?
A. Immediate drainage of 700 mL of blood
B. Blood return of 500 mL the second hour after chest tube insertion
C. Continuous bubbling in the underwater seal of the drainage system
D. Serosanguineous drainage of 100 mL the second hour after chest tube
insertion Correct Ans - Surgical intervention usually is indicated for an
immediate return of 1,000 to 1,500 mL of blood or continued blood loss that
exceeds 200 mL/hour.
Continuous bubbling in the water-seal chamber is expected until the lung had
re-expanded.
Four patients in the emergency department sustained thoracic injuries during
a rollover motor vehicle crash. They are all spontaneously breathing with at
least a minimally acceptable blood pressure. When triaging the patients,
which one takes the highest priority for emergency intervention?
A. A woman with paradoxical chest wall movement
,B. A man with a palpable sternal deformity
C. An adolescent with absent breath sounds on the right side and distended
neck veins
D. A geriatric man with extensive bruising of his chest wall Correct Ans -
Any patient with absent breath sounds on the side of injury, distended neck
veins, tracheal deviation, and hypotension is displaying signs of tension
pneumothorax.
This injury is immediately life threatening because it rapidly compromises
ventilation and circulation.
The patient requires chest tube insertion, emergency needle decompression,
or both.
signs of tension pneumothorax Correct Ans - absent breath sounds on
the side of injury,
distended neck veins,
tracheal deviation, and
hypotension
Why is a pneumothorax considered life threatening injury Correct Ans -
This injury is immediately life threatening because it rapidly compromises
ventilation and circulation.
pneumothorax Treatment: Correct Ans - The patient requires chest
tube insertion, emergency needle decompression, or both.
A patient with a gunshot wound is hemodynamically unstable and has cardiac
tamponade. This patient may benefit most from which treatment?
A. Chest tube insertion
B. Pericardiocentesis
C. Needle decompression
D. Emergency department thoracotomy Correct Ans -
Pericardiocentesis is a temporizing procedure used in the emergency
treatment for hemodynamically unstable patients with cardiac tamponade.
Blood withdrawal from the pericardial sac decreases the compression of the
myocardium and improves cardiac output.
What treatment is most appropriate for a patient with a flail chest?
, A. Perform needle thoracentesis and administer beta-blockers.
B. Provide pain relief and limit fluid intake.
C. Administer histamine (H2)-receptor antagonists and insert a nasogastric
tube.
D. Limit fluid intake and insert a nasogastric tube. Correct Ans - In a
patient with a flail chest, providing pain relief improves breathing
effectiveness. Limiting fluid intake avoids exacerbating the edema and
hemorrhage caused by the pulmonary contusions that usually occur in flail
chest.
Performing needle thoracentesis, administering beta-blockers or histamine
(H2)-receptor antagonists, and inserting a nasogastric tube are not
appropriate interventions for a patient with a flail chest.
A woman presents to the emergency department after being kicked in the
chest by a horse. Which signs and symptoms indicate that the patient is
experiencing cardiac tamponade?
A. Hypotension, muffled heart sounds, and distended neck veins
B. Absent or decreased breath sounds, tracheal deviation, and distended neck
veins
C. Hypertension in the upper extremities, decreased lower extremity pulses,
and intrascapular pain
D. Decreased breath sounds on the injured side, left shoulder pain, and bowel
sounds in the lower chest Correct Ans - Hypotension, muffled heart
sounds, and distended neck veins are a constellation of signs called Beck's
triad that are classic findings in cardiac tamponade. Absent or decreased
breath sounds, tracheal deviation, and distended neck veins suggest a tension
pneumothorax. Hypertension in the upper extremities, decreased lower
extremity pulses, and intrascapular pain are signs of aortic disruption.
Decreased breath sounds on the injured side, left shoulder pain, and bowel
sounds in the lower chest should lead you to suspect a diaphragmatic injury.
Which thoracic injury is associated with rib fractures, flail chest, and scapular
fractures?
A. Pulmonary contusion
B. Cardiac tamponade
C. Fracture of the larynx
D. Aortic disruption Correct Ans - Pulmonary contusions are
associated with rib fractures, flail chest, scapular fractures, hemothorax, and
