Questions 2026 Exam All
Answers and Illustrations
Given
A nurse is reviewing ABG laboratory results of a client who is in
respiratory distress. The results are pH 7.40, PaCO2 32 mm Hg, HCO3
22 mm Hg. The nurse should recognize that the client is experiencing
which of the following acid-base imbalances?
A. Respiratory acidosis
B. Respiratory alkalosis
,C. Metabolic acidosis
D. Metabolic alkalosis - ANSWER ✔✔B. Respiratory alkalosis
(Causes: hyperventilation, fever and respiratory infections)
A nurse is preparing to care for a client following chest tube placement.
Which of the following items should be available in the clients room?
(select all that apply)
A. Oxygen
B. Sterile water
C. Enclosed hemostat clamps
D. Indwelling urinary catheter
E. Occlusive dressing - ANSWER ✔✔A. Oxygen
B. Sterile water
C. enclosed hemostat clamps
E. Occlusive dressing
A nurse is caring for a client who has a chest tube and drainage system
in place. The nurse observes that the chest tube was accidentally
removed. Which of the following actions should the nurse take first?
,A. Obtain a chest x-ray
B. Apply sterile gauze to the insertion site
C. Place tape around the insertion site
D. Assess respiratory status - ANSWER ✔✔B. Apply sterile gauze to
the insertion site (ABC, allows air to escape and decreases risk of
tension pneumothorax)
A nurse is assessing a client who has a chest tube and drainage system
in place. Which of the following are expected findings? (select all that
apply)
A. Continuous bubbling in the water seal chamber
B. Gentle constant bubbling in the suction control chamber
C. Rise and fall in the level of water in the water seal chamber with
inspiration and expiration
D. Exposed sutures without dressing
E. Drainage system upright at chest level - ANSWER ✔✔B. Gentle
constant bubbling in the suction control chamber
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, C. Rise and fall in the level of water in the water seal chamber with
inspiration and expiration
A nurse is assisting a provider with the removal of a chest tube. Which of
the following should the nurse instruct the client to do?
A. Lie on his left side
B. Use the incentive spirometer
C. Cough at regular intervals
D. Perform the Valsalva maneuver - ANSWER ✔✔D. Perform the
Valsalva maneuver (tell client to take a deep breath, exhale and bear
down)
A nurse is planning care for a client following the insertion of a chest
tube and drainage system. Which of the following should be included in
the plan of care? (select all that apply)
A. Encourage the client to cough every 2 hours
B. Check for continuous bubbling in the suction chamber
C. Strip the drainage tubing every 4 hours
D. Clamp the tube once a day