Certified Ambulatory Perianesthesia Nurse (CAPA) Practice Exam

What is one of the earliest physical assessment findings in tension pneumothorax?

1. Generalized cyanosis

2. A deviated point of maximal intensity (PMI)

3. Laryngeal stridor

4. A decrease in breath sounds

The correct answer is: A decrease in breath sounds

In the case of tension pneumothorax, one of the earliest physical assessment findings is a decrease in breath sounds. This occurs because air accumulates in the pleural space, which increases intrathoracic pressure and can lead to lung collapse on the affected side. As the lung becomes increasingly compressed, it results in diminished airflow, which translates to reduced or absent breath sounds when auscultating the chest on that side. The clinical significance of this finding cannot be overstated; it signals compromised ventilation and a need for immediate intervention. Early recognition of the decrease in breath sounds is crucial for timely management of tension pneumothorax, potentially preventing further respiratory distress and cardiovascular compromise. In contrast, other listed options may occur later in the progression of the condition or indicate different pathologies. Generalized cyanosis typically appears after prolonged hypoxia, deviated PMI may suggest other types of cardiac or thoracic issues, and laryngeal stridor represents upper airway obstruction rather than a direct consequence of a pneumothorax. Hence, the prominence of decreased breath sounds in the assessment of tension pneumothorax underscores its importance in clinical practice.