GALEN COLLEGE OF NURSING
Excellence in Nursing Education
MED SURG EXAM 3
COMPREHENSIVE EXAM TEST BANK
Medical-Surgical Nursing | Practice Questions & Rationales
Topics Covered:
Chest Tubes & Respiratory Management | ARDS & Mechanical Ventilation
Tracheostomy Care | Shock & Hemodynamic Monitoring
Burns & Wound Management | Substance Abuse Disorders
Dementia & Psychiatric Nursing | Autoimmune & Transplant Nursing
100+ NCLEX Full
Questions Style Format Rationales Included
For Educational Purposes Only | Galen College of Nursing
Med Surg Exam 3 Test Bank
, TABLE OF CONTENTS
SECTION 1: Chest Tubes & Respiratory Management (Q1–Q17)
SECTION 2: Airway Management & Suctioning (Q18–Q30)
GALEN COLLEGE OF NURSING
SECTION 3: Tracheostomy Care (Q31–Q38)
SECTION 4: ARDS & Mechanical VentilationExcellence
(Q39–Q55)in Nursing Education
SECTION 5: Dementia & Psychiatric Nursing (Q56–Q71)
SECTION 6: Autoimmune, Transplant & Burns (Q72–Q82)
SECTION 7: Substance Abuse Disorders (Q83–Q87)
SECTION 8: Behavioral Health & Miscellaneous (Q91–Q87)
Total Questions: 87 | Full Rationales Included | NCLEX-Style Format
MED SURG EXAM 3
COMPREHENSIVE EXAM TEST BANK
Medical-Surgical Nursing | Practice Questions & Rationales
Topics Covered:
Chest Tubes & Respiratory Management | ARDS & Mechanical Ventilation
Tracheostomy Care | Shock & Hemodynamic Monitoring
Burns & Wound Management | Substance Abuse Disorders
Dementia & Psychiatric Nursing | Autoimmune & Transplant Nursing
100+ NCLEX Full
Questions Style Format Rationales Included
For Educational Purposes Only | Galen College of Nursing
Med Surg Exam 3 Test Bank
,MED SURG EXAM 3 | GALEN COLLEGE OF NURSING Page 3
SECTION 1: Chest Tubes & Respiratory Management
Q1. A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive
cough and chest pain. His chest tube drainage is turbid. What should the nurse request in SBAR
communication with the health care provider?
A. Portable chest X-ray
B. Antibiotic therapy
C. Intubation and mechanical ventilation
D. Arterial blood gasses
✔ CORRECT ANSWER:
Antibiotic therapy
RATIONALE:
Any condition that produces fluid accumulation or sequestration of fluid with infective properties can lead to empyema, an
accumulation of pus in a body cavity, especially the pleural space, as a result of bacterial infection. An infected chest tube site,
lobar pneumonia, and P. carinii pneumonia can lead to fever, chills, and sweating associated with infection. With the symptoms of
infection, antibiotic therapy would be recommended. Nothing in the question demonstrates a need for chest X-ray, intubation, or
ABGs.
Q2. A client has a chest tube inserted for the treatment of a pneumothorax. While turning in the bed, the
client dislodges the tube and it is found in the bed. Place the actions of the registered nurse in the correct
order.
A. Apply an occlusive dressing over the puncture site
B. Tape the dressing on three sides
C. Direct the LPN/VN to notify the health care provider
D. Assess the client's respiratory status
E. Assess vital signs and await further medical orders
✔ CORRECT ANSWER:
1-Apply an occlusive dressing over the puncture site, 2-Tape the dressing on three sides, 3-Direct the LPN/VN to
notify the health care provider, 4-Assess the client's respiratory status, 5-Assess vital signs and await further
medical orders
RATIONALE:
If a chest tube is dislodged and comes out, the nurse would immediately apply an occlusive dressing such as Vaseline gauze. The
dressing is taped on three sides. The first action always focuses on the client. The nurse would direct another licensed nurse to
immediately notify the health care provider. The nurse would then assess the respiratory status. The nurse would obtain vital signs
and await further orders.
Galen College of Nursing — Med Surg Exam 3 Test Bank — For Educational Purposes Only
, MED SURG EXAM 3 | GALEN COLLEGE OF NURSING Page 4
Q3. After having a lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber
chest drainage system. The nurse observes that the drainage system is functioning correctly when noting
which of the following? (Select all that apply)
A. Fluctuations in the water-seal chamber occur when the client breathes
B. Crepitus forms at the chest tube insertion site
C. Intermittent bubbling occurs in the water-seal chamber
D. Gentle bubbling occurs in the suction control chamber
E. Drainage is collecting in the drainage chamber
✔ CORRECT ANSWER:
Fluctuations in the water-seal chamber occur when the client breathes; Intermittent bubbling occurs in the
water-seal chamber; Gentle bubbling occurs in the suction control chamber; Drainage is collecting in the drainage
chamber
RATIONALE:
Fluctuations in the water-seal compartment indicate normal function as pressure in the tubing changes with respirations.
Intermittent bubbling in the water-seal chamber indicates air is being removed from the pleural cavity. Gentle bubbling in the
suction control chamber indicates proper suction level. Drainage is expected after a lobectomy. Crepitus indicates air leaking into
subcutaneous tissues — notify physician.
Q4. The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis
"Risk for injury related to potential dislodgement of chest tube." What should the nurse include as
interventions? (Select all that apply)
A. Keep dry gauze at the bedside
B. Ensure a pair of hemostats are at the bedside
C. Monitor pulse oximetry readings
D. Assess lungs as directed by the physician or as the client's condition warrants
E. Maintain chest tube bottle in an upright position and below the level of the chest
✔ CORRECT ANSWER:
Ensure a pair of hemostats are at the bedside; Monitor pulse oximetry readings; Assess lungs as directed;
Maintain chest tube bottle in an upright position and below the level of the chest
RATIONALE:
A pair of hemostats should be kept at the bedside to clamp the tube should it become dislodged from the drainage container.
Pulse oximetry and lung assessments help ensure proper placement. To maintain proper drainage, the bottle must be kept upright
and below the level of the chest. Vaseline gauze (not dry gauze) is used if the tube is dislodged from the chest.
Q5. The nurse has received a change-of-shift report. The nurse should assess which client first?
A. A 72-year-old admitted 2 days ago with a blood alcohol level of 0.08
B. A 36-year-old with chest tube due to spontaneous pneumothorax with RR 18 and SpO2 95% on O2 at 2 L/min
C. A 28-year-old who is 2 days postappendectomy with discharge prescriptions written
D. A 62-year-old admitted with recent GI bleeding whose hemoglobin is 13.8 g/dL
✔ CORRECT ANSWER:
A 72-year-old admitted 2 days ago with a blood alcohol level of 0.08
RATIONALE:
The nurse should closely monitor the client admitted with an elevated blood alcohol level for signs and symptoms of withdrawal;
delirium tremens peaks at 48 to 72 hours following the last drink. The client with the chest tube is not in distress. The hemoglobin
of 13.8 g/dL is within normal limits. The postappendectomy client is awaiting discharge.
Galen College of Nursing — Med Surg Exam 3 Test Bank — For Educational Purposes Only
Excellence in Nursing Education
MED SURG EXAM 3
COMPREHENSIVE EXAM TEST BANK
Medical-Surgical Nursing | Practice Questions & Rationales
Topics Covered:
Chest Tubes & Respiratory Management | ARDS & Mechanical Ventilation
Tracheostomy Care | Shock & Hemodynamic Monitoring
Burns & Wound Management | Substance Abuse Disorders
Dementia & Psychiatric Nursing | Autoimmune & Transplant Nursing
100+ NCLEX Full
Questions Style Format Rationales Included
For Educational Purposes Only | Galen College of Nursing
Med Surg Exam 3 Test Bank
, TABLE OF CONTENTS
SECTION 1: Chest Tubes & Respiratory Management (Q1–Q17)
SECTION 2: Airway Management & Suctioning (Q18–Q30)
GALEN COLLEGE OF NURSING
SECTION 3: Tracheostomy Care (Q31–Q38)
SECTION 4: ARDS & Mechanical VentilationExcellence
(Q39–Q55)in Nursing Education
SECTION 5: Dementia & Psychiatric Nursing (Q56–Q71)
SECTION 6: Autoimmune, Transplant & Burns (Q72–Q82)
SECTION 7: Substance Abuse Disorders (Q83–Q87)
SECTION 8: Behavioral Health & Miscellaneous (Q91–Q87)
Total Questions: 87 | Full Rationales Included | NCLEX-Style Format
MED SURG EXAM 3
COMPREHENSIVE EXAM TEST BANK
Medical-Surgical Nursing | Practice Questions & Rationales
Topics Covered:
Chest Tubes & Respiratory Management | ARDS & Mechanical Ventilation
Tracheostomy Care | Shock & Hemodynamic Monitoring
Burns & Wound Management | Substance Abuse Disorders
Dementia & Psychiatric Nursing | Autoimmune & Transplant Nursing
100+ NCLEX Full
Questions Style Format Rationales Included
For Educational Purposes Only | Galen College of Nursing
Med Surg Exam 3 Test Bank
,MED SURG EXAM 3 | GALEN COLLEGE OF NURSING Page 3
SECTION 1: Chest Tubes & Respiratory Management
Q1. A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive
cough and chest pain. His chest tube drainage is turbid. What should the nurse request in SBAR
communication with the health care provider?
A. Portable chest X-ray
B. Antibiotic therapy
C. Intubation and mechanical ventilation
D. Arterial blood gasses
✔ CORRECT ANSWER:
Antibiotic therapy
RATIONALE:
Any condition that produces fluid accumulation or sequestration of fluid with infective properties can lead to empyema, an
accumulation of pus in a body cavity, especially the pleural space, as a result of bacterial infection. An infected chest tube site,
lobar pneumonia, and P. carinii pneumonia can lead to fever, chills, and sweating associated with infection. With the symptoms of
infection, antibiotic therapy would be recommended. Nothing in the question demonstrates a need for chest X-ray, intubation, or
ABGs.
Q2. A client has a chest tube inserted for the treatment of a pneumothorax. While turning in the bed, the
client dislodges the tube and it is found in the bed. Place the actions of the registered nurse in the correct
order.
A. Apply an occlusive dressing over the puncture site
B. Tape the dressing on three sides
C. Direct the LPN/VN to notify the health care provider
D. Assess the client's respiratory status
E. Assess vital signs and await further medical orders
✔ CORRECT ANSWER:
1-Apply an occlusive dressing over the puncture site, 2-Tape the dressing on three sides, 3-Direct the LPN/VN to
notify the health care provider, 4-Assess the client's respiratory status, 5-Assess vital signs and await further
medical orders
RATIONALE:
If a chest tube is dislodged and comes out, the nurse would immediately apply an occlusive dressing such as Vaseline gauze. The
dressing is taped on three sides. The first action always focuses on the client. The nurse would direct another licensed nurse to
immediately notify the health care provider. The nurse would then assess the respiratory status. The nurse would obtain vital signs
and await further orders.
Galen College of Nursing — Med Surg Exam 3 Test Bank — For Educational Purposes Only
, MED SURG EXAM 3 | GALEN COLLEGE OF NURSING Page 4
Q3. After having a lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber
chest drainage system. The nurse observes that the drainage system is functioning correctly when noting
which of the following? (Select all that apply)
A. Fluctuations in the water-seal chamber occur when the client breathes
B. Crepitus forms at the chest tube insertion site
C. Intermittent bubbling occurs in the water-seal chamber
D. Gentle bubbling occurs in the suction control chamber
E. Drainage is collecting in the drainage chamber
✔ CORRECT ANSWER:
Fluctuations in the water-seal chamber occur when the client breathes; Intermittent bubbling occurs in the
water-seal chamber; Gentle bubbling occurs in the suction control chamber; Drainage is collecting in the drainage
chamber
RATIONALE:
Fluctuations in the water-seal compartment indicate normal function as pressure in the tubing changes with respirations.
Intermittent bubbling in the water-seal chamber indicates air is being removed from the pleural cavity. Gentle bubbling in the
suction control chamber indicates proper suction level. Drainage is expected after a lobectomy. Crepitus indicates air leaking into
subcutaneous tissues — notify physician.
Q4. The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis
"Risk for injury related to potential dislodgement of chest tube." What should the nurse include as
interventions? (Select all that apply)
A. Keep dry gauze at the bedside
B. Ensure a pair of hemostats are at the bedside
C. Monitor pulse oximetry readings
D. Assess lungs as directed by the physician or as the client's condition warrants
E. Maintain chest tube bottle in an upright position and below the level of the chest
✔ CORRECT ANSWER:
Ensure a pair of hemostats are at the bedside; Monitor pulse oximetry readings; Assess lungs as directed;
Maintain chest tube bottle in an upright position and below the level of the chest
RATIONALE:
A pair of hemostats should be kept at the bedside to clamp the tube should it become dislodged from the drainage container.
Pulse oximetry and lung assessments help ensure proper placement. To maintain proper drainage, the bottle must be kept upright
and below the level of the chest. Vaseline gauze (not dry gauze) is used if the tube is dislodged from the chest.
Q5. The nurse has received a change-of-shift report. The nurse should assess which client first?
A. A 72-year-old admitted 2 days ago with a blood alcohol level of 0.08
B. A 36-year-old with chest tube due to spontaneous pneumothorax with RR 18 and SpO2 95% on O2 at 2 L/min
C. A 28-year-old who is 2 days postappendectomy with discharge prescriptions written
D. A 62-year-old admitted with recent GI bleeding whose hemoglobin is 13.8 g/dL
✔ CORRECT ANSWER:
A 72-year-old admitted 2 days ago with a blood alcohol level of 0.08
RATIONALE:
The nurse should closely monitor the client admitted with an elevated blood alcohol level for signs and symptoms of withdrawal;
delirium tremens peaks at 48 to 72 hours following the last drink. The client with the chest tube is not in distress. The hemoglobin
of 13.8 g/dL is within normal limits. The postappendectomy client is awaiting discharge.
Galen College of Nursing — Med Surg Exam 3 Test Bank — For Educational Purposes Only
