A nurse in the PACU is assessing a client who has an endotracheal tube in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

Choice A reason: Esophageal intubation results in no chest wall expansion bilaterally, as air enters the stomach, not the lungs. The client’s unilateral absence of left-sided expansion suggests air is entering the right lung, indicating the tube is in the trachea but malpositioned, not in the esophagus, which would affect both sides. Choice B reason: Vocal cord infection, or laryngitis, may cause hoarseness or airway swelling but does not cause unilateral chest wall expansion failure. This finding indicates a mechanical issue with ventilation distribution, such as tube malposition. Infection affects mucosal function, not lung expansion, making this an unlikely cause of the observed symptom. Choice C reason: Movement of the endotracheal tube into the right main bronchus causes right-sided ventilation and left-sided collapse, resulting in absent left chest wall expansion. This malposition, common due to the right bronchus’s straighter anatomy, leads to unilateral ventilation, matching the client’s presentation and requiring urgent repositioning to restore bilateral lung function. Choice D reason: Tongue blockage of the endotracheal tube is unlikely, as the tube is placed beyond the oral cavity. Even if obstructed, it would affect both lungs, not just the left. The unilateral absence of expansion points to tube malposition in the right bronchus, selectively ventilating one lung, not a tongue-related obstruction.