E-6 Board Situational Practice Test

Atelectasis is the likely finding here. After surgery, shallow breathing and splinting from pain lead to poor ventilation, especially in the dependent parts of the lungs. The right posterior base is a gravity-dependent area when the patient is supine, so it’s the first region where alveoli collapse. When alveoli collapse, air movement in that area drops, producing diminished breath sounds there despite the chest tube. The chest tube is there to drain air or fluid, but it doesn’t correct the underlying hypoventilation and mucus plugging that cause atelectasis. In contrast, a pneumothorax would often present with clearer signs of air in the pleural space and sometimes tracheal deviation if large; a pleural effusion would more likely cause dullness to percussion and diffuse basilar dullness rather than isolated decreased breath sounds from alveolar collapse; pulmonary edema typically causes crackles rather than localized decreased sounds.