Trauma Nurse Core Course (TNCC) Practice Exam

Which assessment finding is critical in differentiating a tension PTX from a simple PTX?

1. Increased work of breathing

2. Unilaterally diminished breath sounds

3. Pleuritic chest pain

4. Hypotension that worsens with inspiration

The correct answer is: Hypotension that worsens with inspiration

Hypotension that worsens with inspiration is a key finding that helps differentiate a tension pneumothorax from a simple pneumothorax. In tension pneumothorax, air becomes trapped in the pleural space, leading to increasing pressure that collapses the lung on the affected side and shifts the mediastinum toward the opposite side. This increased intrathoracic pressure can compress the great vessels, particularly during inspiration, leading to worsening hypotension and compromised venous return to the heart. In contrast, a simple pneumothorax does not typically cause these profound hemodynamic changes; while it may cause respiratory distress and decreased breath sounds, it does not lead to significant hypotension or cardiovascular compromise. Hence, the critical nature of hypotension, especially as it worsens with inspiration in the case of tension pneumothorax, makes it a distinct and important assessment finding in this scenario.