A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?

Choice A rationale While establishing venous access is important for fluid resuscitation in a trauma client, preparing to insert a central line is not the immediate priority for a sucking chest wound. The client is currently experiencing life-threatening respiratory compromise due to an open pneumothorax. The nurse must prioritize sealing the wound and stabilizing the intrapleural pressure before assisting with invasive central venous access procedures which take more time to set up. Choice B rationale Administering oxygen via nasal cannula is insufficient for a client with a sucking chest wound and a respiratory rate of 40 per minute. The primary problem is the loss of negative intrathoracic pressure, which prevents lung expansion. While oxygen is necessary, providing it through a low-flow cannula does not address the underlying mechanical issue of the open chest wound. High-flow oxygen or assisted ventilation would be more appropriate after the wound is sealed. Choice C rationale Removing the dressing to inspect the wound is contraindicated if the goal is to stabilize the client's breathing. An open chest wound allows atmospheric air to enter the pleural space during inspiration, causing lung collapse. Inspecting the wound without maintaining a seal would allow more air to enter, potentially leading to a tension pneumothorax. The nurse should focus on maintaining an occlusive or semi-occlusive barrier rather than simple visual inspection of the injury. Choice D rationale Applying a non-adherent dressing taped on three sides is the standard emergency intervention for a sucking chest wound. This creates a flutter valve effect where the dressing is sucked against the chest during inhalation, preventing air from entering the pleural space. During exhalation, the untaped side allows air to escape, preventing the accumulation of pressure that leads to a tension pneumothorax. This intervention directly addresses the client's acute respiratory distress and tachycardia.