ATI Med Surge Ch. 18 Chest Tube Insertion Questions, ATI closed-chest
pretest
1. A nurse is providing oral care for a client who is immoblie. Which of
the following actions should the nurse take?: answer- Turn the client
on his side before starting oral care.
2. A nurse is providing discharge teaching to a client who has asthma
and a new prescription for fluticasone/salmeterol. For which of the
following ad-
verse effects should the nurse instruct the client to report to the provider?: -
answer- White coating in the mouth
3. A nurse is preparing an adolescent client who has pneumonia for
percus- sion, vibration, and postural drainage. Prior to the procedure which
of the following nursing actions should the nurse complete first?: answer-
Auscultate lung fields.
4. A nurse is caring for four hospitalized clients. Which of the following
clients should the nurse identify as being at risk for fluid volume deficit?:
,answer- The client who has gastroenteritis and is febrile.
5. A nurse in an urgent care center is caring for a client who is having a
acute asthma exacerbation. Which of the following actions is the nurse's
highest priority?: Administering a nebulized beta-adrenergic
6. A nurse caring for a client who has hypertension and asks the nurse
about a prescription for propranolol. The nurse should inform the client that
this medication is contraindicated in clients who have a history of which of
the following condition?: Asthma
7. A client is admitted to the ED with a respiratory rate of 7/min. Arterial
blood gases (ABG) reveal the following values. Which of the following is
an appropriate of the ABG's?
ph 7.22
PaCO2 68mm
Hg Base excess
-2 PaO2 78 mm
Hg Saturation
80%
,Bicarbonate 26 mEq/q: Respiratory acidosis
Respiratory acidosis occurs when there is retention of CO2 due to an
impairment of respiratory function. It can be the result of respiratory
depression, seen with anesthesia or opioid administration; inadequate
chest expansion, due to a weakness of the respiratory muscles or
constriction to the thorax; an obstruction of the airway, seen in
aspiration, bronchoconstriction, or laryngeal edema; or from an inability
of the lungs to adequately diffuse gases (O2 and CO2), resulting from
conditions such
, as pneumonia, COPD, chest trauma, or pulmonary emboli. Arterial blood
gases will reveal a pH that is lower than the normal reference range
(7.35 - 7.45) and a CO2 level that is higher than the normal reference
range (35 - 45 mm Hg).
8. A nurse is suctioning the endotracheal tube of a client who is on a
ventilator. The client's heart rate increases from 86/min to 110/min and
becomes irreg- ular. Which of the following actions should the nurse take?:
Perform pre-oxy- genation prior to suctioning
9. A nurse is providing discharge teaching to a client who has a new pre-
scription for home oxygen therapy via a nasal cannula. Which of the
following should the nurse include in the teaching? (sata): Check the
cannula position on a regular basis
Check the tops of the ears for skin breakdown
Post "no smoking" signs in a prominent location in the home
10.A nurse is developing a plan of care for a client who is postoperative.
Which of the following interventions should the nurse included in the plan to
pretest
1. A nurse is providing oral care for a client who is immoblie. Which of
the following actions should the nurse take?: answer- Turn the client
on his side before starting oral care.
2. A nurse is providing discharge teaching to a client who has asthma
and a new prescription for fluticasone/salmeterol. For which of the
following ad-
verse effects should the nurse instruct the client to report to the provider?: -
answer- White coating in the mouth
3. A nurse is preparing an adolescent client who has pneumonia for
percus- sion, vibration, and postural drainage. Prior to the procedure which
of the following nursing actions should the nurse complete first?: answer-
Auscultate lung fields.
4. A nurse is caring for four hospitalized clients. Which of the following
clients should the nurse identify as being at risk for fluid volume deficit?:
,answer- The client who has gastroenteritis and is febrile.
5. A nurse in an urgent care center is caring for a client who is having a
acute asthma exacerbation. Which of the following actions is the nurse's
highest priority?: Administering a nebulized beta-adrenergic
6. A nurse caring for a client who has hypertension and asks the nurse
about a prescription for propranolol. The nurse should inform the client that
this medication is contraindicated in clients who have a history of which of
the following condition?: Asthma
7. A client is admitted to the ED with a respiratory rate of 7/min. Arterial
blood gases (ABG) reveal the following values. Which of the following is
an appropriate of the ABG's?
ph 7.22
PaCO2 68mm
Hg Base excess
-2 PaO2 78 mm
Hg Saturation
80%
,Bicarbonate 26 mEq/q: Respiratory acidosis
Respiratory acidosis occurs when there is retention of CO2 due to an
impairment of respiratory function. It can be the result of respiratory
depression, seen with anesthesia or opioid administration; inadequate
chest expansion, due to a weakness of the respiratory muscles or
constriction to the thorax; an obstruction of the airway, seen in
aspiration, bronchoconstriction, or laryngeal edema; or from an inability
of the lungs to adequately diffuse gases (O2 and CO2), resulting from
conditions such
, as pneumonia, COPD, chest trauma, or pulmonary emboli. Arterial blood
gases will reveal a pH that is lower than the normal reference range
(7.35 - 7.45) and a CO2 level that is higher than the normal reference
range (35 - 45 mm Hg).
8. A nurse is suctioning the endotracheal tube of a client who is on a
ventilator. The client's heart rate increases from 86/min to 110/min and
becomes irreg- ular. Which of the following actions should the nurse take?:
Perform pre-oxy- genation prior to suctioning
9. A nurse is providing discharge teaching to a client who has a new pre-
scription for home oxygen therapy via a nasal cannula. Which of the
following should the nurse include in the teaching? (sata): Check the
cannula position on a regular basis
Check the tops of the ears for skin breakdown
Post "no smoking" signs in a prominent location in the home
10.A nurse is developing a plan of care for a client who is postoperative.
Which of the following interventions should the nurse included in the plan to
