NR 325: Adult Health III Complex Care Comprehensive Midterm Review Comprehensive Knowledge Assessment and Review Guide: Advanced Test Bank, Detailed Practice Questions, Final Exam Preparation, and Complete Study Companion

A client with a large pleural effusion is scheduled for thoracentesis. Which position should the nurse use to facilitate the safest and most effective access to the pleural space? A. Supine with the head of the bed slightly elevated B. Prone with both arms extended above the head C. Sitting upright and leaning forward over a bedside table D. Side-lying on the unaffected side with the knees flexed Correct Answer: C. Sitting upright and leaning forward over a bedside table Rationale: Sitting upright and leaning forward helps widen the intercostal spaces and provides better access to the pleural space. Supine and prone positions can limit access and may worsen respiratory difficulty. Side-lying may be used when the client cannot sit upright but is not the preferred position when upright positioning is tolerated. Question 2 Immediately following thoracentesis, a client develops sudden dyspnea, hypotension, and diminished breath sounds on the affected side. Which complication should the nurse suspect? A. Pulmonary embolism B. Tension pneumothorax C. Acute bronchitis D. Pleural infection Correct Answer: B. Tension pneumothorax Rationale: Sudden respiratory distress, hypotension, and unilateral diminished breath sounds after thoracentesis strongly suggest a pneumothorax with compression of the lung and mediastinal structures. This is an emergency requiring immediate intervention. Pleural infection and bronchitis generally develop more gradually. Question 3 The nurse is preparing a client’s room for a thoracentesis. Which equipment is most important to have readily available? A. Oxygen equipment, pulse oximeter, and sterile dressing supplies B. Incentive spirometer, urinary catheter, and suture-removal kit C. Defibrillator pads, nasogastric tube, and traction equipment D. Mechanical ventilator, chest binder, and enteral feeding pump Correct Answer: A. Oxygen equipment, pulse oximeter, and sterile dressing supplies Rationale: Oxygen and pulse oximetry are important because thoracentesis can cause respiratory complications such as pneumothorax and hypoxemia. Sterile dressing supplies are needed to cover the puncture site after the procedure. The other equipment is not routinely required for thoracentesis. Question 4 Which finding after thoracentesis requires the nurse’s most immediate intervention? A. Mild discomfort at the puncture site B. A small spot of blood on the dressing C. Sudden shortness of breath and tachycardia D. A dry cough lasting several minutes Correct Answer: C. Sudden shortness of breath and tachycardia Rationale: Sudden dyspnea and tachycardia may indicate pneumothorax, bleeding, or another acute complication. The nurse should immediately assess respiratory status and notify the healthcare provider as appropriate. Mild localized discomfort, scant drainage, and temporary coughing can occur after the procedure and are generally less urgent. Question 5 A client scheduled for pulmonary function testing asks how to prepare for the procedure. Which instruction should the nurse provide? A. “Smoke only one cigarette during the six hours before the test.” B. “Avoid smoking for at least six to eight hours before testing.” C. “Use all prescribed bronchodilators immediately before the test.” D. “Remain NPO beginning at midnight before the procedure.” Correct Answer: B. “Avoid smoking for at least six to eight hours before testing.” Rationale: Smoking can alter airway resistance and interfere with pulmonary function test results. Clients are generally instructed to avoid smoking for six to eight hours before testing. Bronchodilators may need to be withheld according to the provider’s instructions. Complete fasting is usually unnecessary, although large meals should generally be avoided immediately before testing. Question 6 During pulmonary function testing, which measurement represents the maximum amount of air contained in the lungs after the client inhales as deeply as possible? A. Residual volume B. Vital capacity C. Functional residual capacity D. Total lung capacity Correct Answer: D. Total lung capacity Rationale: Total lung capacity is the total volume of air contained in the lungs following maximal inhalation. Vital capacity is the maximum amount of air that can be exhaled after maximal inhalation. Residual volume is the air remaining after forced expiration, while functional residual capacity is the volume remaining after a normal passive expiration. Question 7 A nurse is preparing a client for bronchoscopy. Which action is most appropriate? A. Allow clear liquids until one hour before the procedure B. Verify that informed consent has been obtained and that the client understands the procedure C. Instruct the client to maintain the neck in a flexed position D. Administer a full meal to prevent medication-related nausea Correct Answer: B. Verify that informed consent has been obtained and that the client understands the procedure Rationale: The provider explains the procedure and obtains informed consent. The nurse should verify that the consent is signed and that the client understands the information provided. The client should remain NPO for the prescribed period to reduce aspiration risk. Neck positioning during bronchoscopy is adjusted to facilitate passage of the bronchoscope. Question 8 A client is being monitored after bronchoscopy. Which assessment finding requires immediate reporting to the healthcare provider? A. Mild sore throat B. Small amount of blood-tinged sputum C. Transient nonproductive cough D. Bronchospasm with increasing respiratory effort Correct Answer: D. Bronchospasm with increasing respiratory effort Rationale: Bronchospasm can rapidly compromise airway patency and ventilation, making it the priority finding. A mild sore throat, brief coughing, and a small amount of bloodtinged sputum may occur because of airway irritation from the bronchoscope. Persistent or large-volume bleeding would also require prompt evaluation. Question 9 Before offering oral fluids to a client following bronchoscopy, which assessment should the nurse perform first? A. Peripheral pulse quality B. Bowel sounds C. Gag reflex D. Urinary output Correct Answer: C. Gag reflex Rationale: Topical anesthetics and sedation can temporarily suppress the gag reflex, increasing the risk of aspiration. The nurse should verify that the gag reflex has returned before allowing oral fluids, food, or medications. The other assessments do not determine whether the client can safely swallow. Question 10 Which statement by a client scheduled for bronchoscopy indicates correct understanding of the procedure? A. “I may have a tissue specimen removed during the examination.” B. “I can leave my dentures in place throughout the procedure.” C. “I will not need to sign a consent form.” D. “I can drink clear liquids until the procedure begins.” Correct Answer: A. “I may have a tissue specimen removed during the examination.” Rationale: Bronchoscopy allows direct visualization of the airways and may include biopsy, secretion removal, or specimen collection. Dentures should be removed to reduce the risk of aspiration or damage. Informed consent is required because bronchoscopy is an invasive procedure, and the client should remain NPO for the prescribed period before the procedure to reduce aspiration risk.