NU 214 Exam 2 Questions With
Complete Answers
The nurse has just auscultated course crackles bilaterally on a patient with a
tracheostomy tube in place. If the patient is unsuccessful in coughing up
secretions, what action should the nurse take?
a. Encourage increased incentive spirometer use
b. Encourage the pt to increase oral fluid intake
c. Put on sterile gloves and use a sterile catheter to suction
d. Preoxygenate the pt for 3 minutes before suctioning - ANSWER C. Put on
sterile gloves and use a sterile catheter to suction
After change of shift report, which patient should the nurse assess first?
a. A 72 year old with cot pulmonary who has 4+ bilateral edema in his legs and
feet
b. A 28 year old with a history of lung transplant and a temp of 101F
c. A 40 year old with a pleural effusion who is complaining of severe stabbing
chest pain
d. A 64 year old with lung cancer and tracheal deviation after subclavian
catheter insertion - ANSWER d. A 64 year old with lung cancer and tracheal
deviation after subclavian catheter insertion
A patient is admitted to the emergency department was in open stabbing to the
left chest. What is the first action that the nurse should take?
a. Position the pt so that the left chest is dependent
b. Tape a non-porous dressing on three sides over the chest wound
c. Cover the sucking wound firmly with occlusive dressing
d. Keep the HOB at no more than 30 degrees elevation - ANSWER b. Tape a non-
porous dressing on three sides over the chest wound
The nurse cares for a patient who has just had a thoracentesis. Which
assessment information obtained by the nurse is a priority to communicate to
the healthcare provider?
a. Oxygen saturation of 88%
b. BP of 145/90mmhg
c. Respiratory rate is 22 breaths/minute when lying flat
d. Pain level is 5 (on 0 to 10 scale) with a deep breath - ANSWER a. Oxygen
saturation of 88%
Complete Answers
The nurse has just auscultated course crackles bilaterally on a patient with a
tracheostomy tube in place. If the patient is unsuccessful in coughing up
secretions, what action should the nurse take?
a. Encourage increased incentive spirometer use
b. Encourage the pt to increase oral fluid intake
c. Put on sterile gloves and use a sterile catheter to suction
d. Preoxygenate the pt for 3 minutes before suctioning - ANSWER C. Put on
sterile gloves and use a sterile catheter to suction
After change of shift report, which patient should the nurse assess first?
a. A 72 year old with cot pulmonary who has 4+ bilateral edema in his legs and
feet
b. A 28 year old with a history of lung transplant and a temp of 101F
c. A 40 year old with a pleural effusion who is complaining of severe stabbing
chest pain
d. A 64 year old with lung cancer and tracheal deviation after subclavian
catheter insertion - ANSWER d. A 64 year old with lung cancer and tracheal
deviation after subclavian catheter insertion
A patient is admitted to the emergency department was in open stabbing to the
left chest. What is the first action that the nurse should take?
a. Position the pt so that the left chest is dependent
b. Tape a non-porous dressing on three sides over the chest wound
c. Cover the sucking wound firmly with occlusive dressing
d. Keep the HOB at no more than 30 degrees elevation - ANSWER b. Tape a non-
porous dressing on three sides over the chest wound
The nurse cares for a patient who has just had a thoracentesis. Which
assessment information obtained by the nurse is a priority to communicate to
the healthcare provider?
a. Oxygen saturation of 88%
b. BP of 145/90mmhg
c. Respiratory rate is 22 breaths/minute when lying flat
d. Pain level is 5 (on 0 to 10 scale) with a deep breath - ANSWER a. Oxygen
saturation of 88%
