A client develops a sudden onset of chest pain, shortness of breath, and hypotension after a central line placement. The nurse suspects a pneumothorax. What is the PRIORITY action?

TENSION PNEUMOTHORAX is a potentially fatal complication of central line placement (and other thoracic procedures). It occurs when air enters the pleural space and cannot escape, progressively compressing the lung and eventually shifting the mediastinum (tension). CLINICAL PRESENTATION: Sudden chest pain; acute dyspnea; hypotension; decreased or absent breath sounds on one side; tracheal deviation (late sign, shifting away from the affected side); hypoxia; tachycardia progressing to cardiovascular collapse. PRIORITY ACTIONS — TIME IS CRITICAL: (1) STAY WITH CLIENT — do not leave; (2) ACTIVATE RAPID RESPONSE or code team per facility protocol; (3) SUPPLEMENTAL OXYGEN — high-flow via non-rebreather mask; (4) CALL PHYSICIAN STAT — tension pneumothorax requires immediate needle decompression (needle thoracostomy) by the physician, followed by chest tube; (5) PREPARE FOR EMERGENCY INTERVENTION — anticipate needle decompression and chest tube setup; (6) CONTINUOUS MONITORING — SpO2, blood pressure, respiratory status every few minutes. WHY NOT WAIT FOR X-RAY: Tension pneumothorax is a clinical diagnosis in an emergency — waiting for X-ray while the client decompensates can result in cardiac arrest. Clinical findings of tension pneumothorax require immediate treatment. The physician will typically perform needle decompression based on clinical presentation before X-ray confirmation. NURSE'S ROLE: The nurse cannot perform needle thoracostomy — that is a physician/advanced practice procedure — but the nurse's rapid recognition, notification, and preparation are what determine the outcome.