# A 28-year-old male is brought to the emergency department after a motor vehicle collision. He is tachypneic, using accessory muscles, and has tracheal deviation to the right. Breath sounds are absent on the left. Heart rate is 130/min, blood pressure is 82/50 mm Hg, and oxygen saturation is 86% on room air. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505812&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

A 28-year-old male is brought to the emergency department after a motor vehicle collision. He is tachypneic, using accessory muscles, and has tracheal deviation to the right. Breath sounds are absent on the left. Heart rate is 130/min, blood pressure is 82/50 mm Hg, and oxygen saturation is 86% on room air. Which action should the nurse take first?

## Option

1. Obtain a portable chest x-ray to confirm the diagnosis.
2. Prepare for immediate needle decompression of the left chest. **✔ Correct answer**
3. Administer 100% oxygen via non-rebreather mask and reassess in 15 minutes.
4. Insert a large-bore intravenous line and start rapid fluid resuscitation.

**Correct answer: 2**

## Explanation

The patient’s presentation—severe respiratory distress, tracheal deviation, absent breath sounds on the left, hypotension, and tachycardia—is classic for tension pneumothorax, a life-threatening emergency. Immediate needle decompression is the priority to relieve pressure and restore cardiac output; waiting for a chest x-ray delays definitive treatment and risks cardiac arrest. Administering oxygen alone does not address the underlying air trapping, and fluid resuscitation, while potentially needed for hypotension, is secondary to decompression. The nurse must recognize obstructive shock and prepare for emergent decompression without delay.

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