Respiratory Question #24


A client arrives to the emergency department following an automobile accident and has multiple fractured ribs. The nurse suspects flail chest because of which cardinal sign?


  1. Paradoxical chest movement.
    • Rationale:
  2. Dyspnea on expiration.
    • Rationale:
  3. Blue nail beds.
    • Rationale:
  4. Hypertension.
    • Rationale:



In flail chest, broken rib segments move independently of the rest of the rib cage due to multiple rib fractures causing paradoxical chest movement. During inspiration, the fractured segment is pulled inward while the rest of the chest expands. During expiration, the segment spreads outward while the rest of the chest moves inward. While dyspnea, cyanosis of nail beds and other areas, and hypertension may be caused by other issues, the key is to search for findings that exhibit flail chest and not other conditions as well.

Learning Outcomes

Test Taking Tip

Video Rationale