,NU189/NU 189 Exam 3 | Medical-Surgical Nursing II |
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the priority action when a patient with a chest tube experiences
sudden disconnection from the drainage system?
A) Clamp the chest tube immediately to prevent air entry
B) Place the end of the chest tube in a container of sterile water
C) Reconnect the tube to the drainage system and tape the connection
D) Notify the provider and prepare for chest tube re-insertion
Correct Answer: Place the end of the chest tube in a container of sterile water
Expert Rationale: Placing the disconnected end under sterile water creates an underwater seal,
preventing air from entering the pleural space and causing a tension pneumothorax. Clamping can lead
to tension pneumothorax if air is already trapped. The provider is notified after immediate action is
taken.
2. The nurse observes fluctuation of the water level in the water seal chamber of a chest tube with each
respiration. Which action is required?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Continue to monitor; this is a normal finding
D) Prepare for chest tube removal
Correct Answer: Continue to monitor; this is a normal finding
Expert Rationale: Tidaling (fluctuation of the water level with breathing) indicates that the chest tube is
patent and the system is functioning properly. No intervention is needed; the nurse should document
the finding and continue routine monitoring. Clamping or notifying the provider is unnecessary for this
expected finding.
,3. A patient with a chest tube accidentally pulls the tube partially out of the insertion site. What should
the nurse do first?
A) Push the tube back into the insertion site
B) Apply an occlusive dressing over the site
C) Clamp the chest tube and notify the provider
D) Assess the patient's respiratory status and vital signs
Correct Answer: Assess the patient's respiratory status and vital signs
Expert Rationale: The priority is to assess the patient's respiratory status and vital signs to determine if a
pneumothorax has developed. Applying an occlusive dressing may be necessary, but assessment comes
first. Pushing the tube back in is contraindicated due to infection risk.
4. Which set of findings is most consistent with cardiac tamponade?
A) Hypertension, bounding pulses, and warm skin
B) Hypotension, muffled heart sounds, and jugular vein distention
C) Tachycardia, crackles, and peripheral edema
D) Bradycardia, hypertension, and widened pulse pressure
Correct Answer: Hypotension, muffled heart sounds, and jugular vein distention
Expert Rationale: Cardiac tamponade presents with Beck's triad: hypotension, muffled heart sounds, and
jugular vein distention. These result from compression of the heart by accumulated fluid in the
pericardial sac, reducing cardiac output and impairing filling.
5. A patient with a pneumothorax is at risk for which type of shock?
A) Cardiogenic shock
B) Hypovolemic shock
C) Obstructive shock
D) Distributive shock
, Correct Answer: Obstructive shock
Expert Rationale: A pneumothorax can cause obstructive shock by compressing the heart and great
vessels, reducing venous return and cardiac output. This is distinct from cardiogenic, hypovolemic, or
distributive shock, which have different pathophysiologic mechanisms.
6. Which hemodynamic finding is characteristic of septic shock?
A) Increased systemic vascular resistance and decreased cardiac output
B) Decreased systemic vascular resistance and increased cardiac output
C) Increased systemic vascular resistance and increased cardiac output
D) Decreased systemic vascular resistance and decreased cardiac output
Correct Answer: Decreased systemic vascular resistance and increased cardiac output
Expert Rationale: Septic shock is characterized by vasodilation (decreased SVR) and a hyperdynamic
state with increased cardiac output. This is due to the release of inflammatory mediators causing
widespread vasodilation and capillary leak.
7. A patient is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient?
A) Position the patient supine with legs elevated
B) Position the patient sitting upright, leaning forward over a table
C) Position the patient in a high Fowler's position with arms crossed
D) Position the patient in a left lateral decubitus position
Correct Answer: Position the patient sitting upright, leaning forward over a table
Expert Rationale: For thoracentesis, the patient should be positioned sitting upright, leaning forward
over a table to widen the intercostal spaces. This allows for safe needle insertion and fluid removal. The
patient must remain still and in the proper position during the procedure.
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the priority action when a patient with a chest tube experiences
sudden disconnection from the drainage system?
A) Clamp the chest tube immediately to prevent air entry
B) Place the end of the chest tube in a container of sterile water
C) Reconnect the tube to the drainage system and tape the connection
D) Notify the provider and prepare for chest tube re-insertion
Correct Answer: Place the end of the chest tube in a container of sterile water
Expert Rationale: Placing the disconnected end under sterile water creates an underwater seal,
preventing air from entering the pleural space and causing a tension pneumothorax. Clamping can lead
to tension pneumothorax if air is already trapped. The provider is notified after immediate action is
taken.
2. The nurse observes fluctuation of the water level in the water seal chamber of a chest tube with each
respiration. Which action is required?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Continue to monitor; this is a normal finding
D) Prepare for chest tube removal
Correct Answer: Continue to monitor; this is a normal finding
Expert Rationale: Tidaling (fluctuation of the water level with breathing) indicates that the chest tube is
patent and the system is functioning properly. No intervention is needed; the nurse should document
the finding and continue routine monitoring. Clamping or notifying the provider is unnecessary for this
expected finding.
,3. A patient with a chest tube accidentally pulls the tube partially out of the insertion site. What should
the nurse do first?
A) Push the tube back into the insertion site
B) Apply an occlusive dressing over the site
C) Clamp the chest tube and notify the provider
D) Assess the patient's respiratory status and vital signs
Correct Answer: Assess the patient's respiratory status and vital signs
Expert Rationale: The priority is to assess the patient's respiratory status and vital signs to determine if a
pneumothorax has developed. Applying an occlusive dressing may be necessary, but assessment comes
first. Pushing the tube back in is contraindicated due to infection risk.
4. Which set of findings is most consistent with cardiac tamponade?
A) Hypertension, bounding pulses, and warm skin
B) Hypotension, muffled heart sounds, and jugular vein distention
C) Tachycardia, crackles, and peripheral edema
D) Bradycardia, hypertension, and widened pulse pressure
Correct Answer: Hypotension, muffled heart sounds, and jugular vein distention
Expert Rationale: Cardiac tamponade presents with Beck's triad: hypotension, muffled heart sounds, and
jugular vein distention. These result from compression of the heart by accumulated fluid in the
pericardial sac, reducing cardiac output and impairing filling.
5. A patient with a pneumothorax is at risk for which type of shock?
A) Cardiogenic shock
B) Hypovolemic shock
C) Obstructive shock
D) Distributive shock
, Correct Answer: Obstructive shock
Expert Rationale: A pneumothorax can cause obstructive shock by compressing the heart and great
vessels, reducing venous return and cardiac output. This is distinct from cardiogenic, hypovolemic, or
distributive shock, which have different pathophysiologic mechanisms.
6. Which hemodynamic finding is characteristic of septic shock?
A) Increased systemic vascular resistance and decreased cardiac output
B) Decreased systemic vascular resistance and increased cardiac output
C) Increased systemic vascular resistance and increased cardiac output
D) Decreased systemic vascular resistance and decreased cardiac output
Correct Answer: Decreased systemic vascular resistance and increased cardiac output
Expert Rationale: Septic shock is characterized by vasodilation (decreased SVR) and a hyperdynamic
state with increased cardiac output. This is due to the release of inflammatory mediators causing
widespread vasodilation and capillary leak.
7. A patient is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient?
A) Position the patient supine with legs elevated
B) Position the patient sitting upright, leaning forward over a table
C) Position the patient in a high Fowler's position with arms crossed
D) Position the patient in a left lateral decubitus position
Correct Answer: Position the patient sitting upright, leaning forward over a table
Expert Rationale: For thoracentesis, the patient should be positioned sitting upright, leaning forward
over a table to widen the intercostal spaces. This allows for safe needle insertion and fluid removal. The
patient must remain still and in the proper position during the procedure.
