medium · NCLEX-RN physiological
A client is admitted with a suspected tension pneumothorax. The nurse notes the following: Blood pressure 78/42 mmHg, Heart Rate 136/min, SpO2 82%, and the trachea is deviated to the right.
Which intervention should the nurse anticipate first?
- Administration of a 1 L 0.9% saline bolus to improve blood pressure
- Immediate needle decompression of the left pleural space, for this client.
- Transporting the client to the radiology department for a STAT chest X-ray
- Endotracheal intubation and initiation of positive pressure ventilation
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