Which of the following would NOT be a sign of tension pneumothorax?

In the context of tension pneumothorax, the presence of increased breath sounds on the affected side is not typically observed. In fact, one of the hallmark characteristics of tension pneumothorax is the absence or decreased breath sounds on the affected side due to the accumulation of air in the pleural space, which compromises lung expansion and function.

When air enters the pleural space and cannot escape, it creates increasing pressure that can lead to significant respiratory and hemodynamic compromise. The other signs, such as jugular venous distension, tachycardia, and tracheal deviation, indicate the physiological stress and mediastinal shifting that occurs as a result of the pressure buildup. Jugular venous distension occurs due to impaired venous return to the heart, tachycardia is a compensatory mechanism to maintain cardiac output, and tracheal deviation indicates displacement of structures within the mediastinum, further reflecting the severity of the condition. Thus, the presence of breath sounds on the affected side would be unexpected in this scenario, affirming the choice of increased breath sounds as the correct answer.