A patient is diagnosed with chest pneumothorax. The on-duty nursing officer anticipates that which test will be ordered by the doctor before chest tube insertion?

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

A chest X-ray is the definitive, non-invasive imaging study used to confirm the diagnosis of a pneumothorax.
It is essential for visualizing the presence of air in the pleural space, determining the percentage of lung collapse, and identifying the exact location (left or right side).
This information is critical for the healthcare provider to confirm the need for a chest tube and to guide its safe and accurate placement.
The image provided is a classic example of a chest X-ray used to diagnose a significant pneumothorax.

Option B: A hemoglobin (Hb) test measures the amount of hemoglobin in the blood. It does not provide any information about the presence of air in the pleural space.
Option C: Assessing vital signs is a fundamental nursing action for monitoring a patient's stability, not a diagnostic test ordered by a physician to confirm a diagnosis.
Option D: Bronchoscopy involves visualizing the inside of the trachea and bronchi. A pneumothorax is a condition of the pleural space, which is outside the lung and cannot be seen with a bronchoscope.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Pneumothorax Diagnosis and Management in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's ability to anticipate the need for a chest X-ray in a patient with suspected pneumothorax can expedite diagnosis and treatment, preventing potential complications.
The nurse plays a vital role in preparing the patient and equipment for chest tube insertion, as well as in the crucial post-procedure monitoring of the patient and the chest drainage system.
What if the patient suddenly becomes hypotensive, tachycardic, and has tracheal deviation? In this case of a suspected tension pneumothorax, the diagnosis is made clinically, and emergency needle decompression is performed immediately, without waiting for a chest X-ray.

How to Approach the Question

First, identify the patient's condition from the question stem: 'chest pneumothorax'.
Next, identify the planned intervention: 'chest tube insertion'.
The question asks for the 'test' that would be ordered 'before' this intervention.
Evaluate the options: A chest X-ray visualizes the lungs and pleural space. Hb is a blood test. Vitals are clinical measurements. Bronchoscopy looks inside the airways.
Conclude that a visual confirmation of the problem (air in the pleural space) is necessary to guide the invasive procedure. Therefore, a chest X-ray is the most logical and standard diagnostic test to order.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 2-4

E6 Medicine Harrison 22e Part 2 p. 175-177

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 492-494

Practise the full NORCET 2 - 2021 (shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.