GALEN COLLEGE OF NURSING – NU 189
MEDICAL-SURGICAL NURSING II EXAM 3 –
QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
SECTION 1: CHEST TUBES, THORACIC PROCEDURES & MECHANICAL VENTILATION
Questions 1–25
1.
A nurse assesses a client with a chest tube and observes fluctuation of fluid in the water-seal
chamber during inspiration and expiration. Which interpretation is most appropriate?
A) The fluctuation indicates normal tidaling in a functioning chest-drainage system.
B) The chest tube should immediately be clamped.
C) The drainage system has become disconnected.
D) The client is developing tension pneumothorax.
Correct Answer: The fluctuation indicates normal tidaling in a functioning chest-drainage
system.
Rationale: Tidaling refers to expected movement of fluid in the water-seal chamber with
respiration. It generally indicates that pressure changes are being transmitted through a
patent drainage system. Absence of tidaling may occur when the lung has fully re-expanded
or when the tubing is obstructed, so the finding must be interpreted in context.
2.
A client with a chest tube becomes accidentally disconnected from the drainage system.
What should the nurse do first?
A) Remove the chest tube.
B) Place the end of the chest tube in sterile water.
C) Clamp the tube for several minutes.
D) Increase the wall suction pressure.
Correct Answer: Place the end of the chest tube in sterile water.
,Rationale: Placing the disconnected chest-tube end into sterile water temporarily recreates a
water seal and helps prevent atmospheric air from entering the pleural space. The nurse
should then obtain a new drainage system and reconnect it according to institutional
procedure. Routine clamping can cause dangerous pressure accumulation.
3.
Which assessment finding most strongly suggests that a client has developed a
pneumothorax?
A) Bilateral crackles and dependent edema
B) Productive cough with purulent sputum
C) Sudden unilateral diminished or absent breath sounds
D) Gradually increasing bilateral pedal edema
Correct Answer: Sudden unilateral diminished or absent breath sounds
Rationale: Pneumothorax involves air entering the pleural space and interfering with normal
lung expansion. Sudden unilateral reduction or absence of breath sounds is a classic finding,
particularly when accompanied by acute dyspnea or pleuritic pain. Crackles and peripheral
edema point toward other cardiopulmonary processes rather than an acute pneumothorax.
4.
A client is scheduled for thoracentesis. Which position should the nurse anticipate?
A) Supine with the legs elevated
B) Prone with the head turned to the side
C) Flat with both arms at the sides
D) Sitting upright and leaning forward with the arms supported
Correct Answer: Sitting upright and leaning forward with the arms supported
Rationale: Sitting upright and leaning forward helps widen the intercostal spaces and
facilitates access to the pleural cavity. The client should remain as still as possible during the
procedure to reduce the risk of injury. Positioning is particularly important because
movement can interfere with accurate needle placement.
5.
Before a video-assisted thoracic surgery procedure, which assessment is especially
important for establishing a respiratory baseline?
A) Auscultating breath sounds bilaterally
,B) Measuring abdominal girth
C) Testing visual acuity
D) Assessing bowel sounds only
Correct Answer: Auscultating breath sounds bilaterally
Rationale: VATS is a thoracic procedure, so a baseline respiratory assessment provides
information against which postoperative findings can be compared. Bilateral breath sounds
help identify preexisting abnormalities and later changes such as atelectasis or
pneumothorax. Abdominal, visual, and bowel assessments may be relevant generally but do
not establish the key respiratory baseline.
6.
A mechanically ventilated client triggers a high-pressure alarm. What should the nurse
assess first?
A) Whether the ventilator is unplugged
B) Whether the tubing is kinked or obstructed
C) Whether the oxygen cylinder is empty
D) Whether the client has stopped breathing
Correct Answer: Whether the tubing is kinked or obstructed
Rationale: A high-pressure alarm commonly indicates increased resistance to airflow. The
nurse should rapidly assess the client and then inspect the ventilator circuit for kinks,
secretions, biting, or other obstruction. Low-pressure alarms are more commonly associated
with disconnection or leaks, whereas high pressure suggests resistance.
7.
Which situation is most consistent with a low-pressure ventilator alarm?
A) Thick secretions obstructing the endotracheal tube
B) Bronchospasm increasing airway resistance
C) Disconnection or a leak in the ventilator circuit
D) The client biting the endotracheal tube
Correct Answer: Disconnection or a leak in the ventilator circuit
Rationale: A low-pressure alarm generally means the ventilator is not encountering the
expected resistance or pressure because delivered gas is escaping. Disconnection, cuff
, leakage, or circuit separation can cause this pattern. Obstruction, bronchospasm, and biting
increase airway resistance and are therefore more consistent with high-pressure alarms.
8.
A ventilated client suddenly becomes restless and oxygen saturation falls. Which action
should take priority?
A) Silence the alarm and leave the room.
B) Document the ventilator settings.
C) Wait for the next scheduled respiratory assessment.
D) Immediately assess the client and airway.
Correct Answer: Immediately assess the client and airway.
Rationale: Ventilator alarms must never be treated as merely equipment problems until the
client has been assessed. Acute restlessness and falling oxygen saturation may indicate
airway obstruction, tube displacement, pneumothorax, or another life-threatening problem.
The nurse should assess breathing, oxygenation, airway patency, and circulation while
troubleshooting the equipment.
9.
Which finding after thoracentesis requires the most immediate attention?
A) Mild soreness at the puncture site
B) Sudden dyspnea and decreased breath sounds
C) Small amount of localized bruising
D) Temporary anxiety about the procedure
Correct Answer: Sudden dyspnea and decreased breath sounds
Rationale: Sudden respiratory distress and decreased breath sounds following thoracentesis
may indicate an iatrogenic pneumothorax. This complication can impair ventilation and
become life-threatening if it progresses. Mild soreness, bruising, and anxiety may occur after
an invasive procedure but are generally less urgent than acute respiratory deterioration.
10.
A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this finding most likely indicate?
A) Normal tidaling
B) Complete lung re-expansion
MEDICAL-SURGICAL NURSING II EXAM 3 –
QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
SECTION 1: CHEST TUBES, THORACIC PROCEDURES & MECHANICAL VENTILATION
Questions 1–25
1.
A nurse assesses a client with a chest tube and observes fluctuation of fluid in the water-seal
chamber during inspiration and expiration. Which interpretation is most appropriate?
A) The fluctuation indicates normal tidaling in a functioning chest-drainage system.
B) The chest tube should immediately be clamped.
C) The drainage system has become disconnected.
D) The client is developing tension pneumothorax.
Correct Answer: The fluctuation indicates normal tidaling in a functioning chest-drainage
system.
Rationale: Tidaling refers to expected movement of fluid in the water-seal chamber with
respiration. It generally indicates that pressure changes are being transmitted through a
patent drainage system. Absence of tidaling may occur when the lung has fully re-expanded
or when the tubing is obstructed, so the finding must be interpreted in context.
2.
A client with a chest tube becomes accidentally disconnected from the drainage system.
What should the nurse do first?
A) Remove the chest tube.
B) Place the end of the chest tube in sterile water.
C) Clamp the tube for several minutes.
D) Increase the wall suction pressure.
Correct Answer: Place the end of the chest tube in sterile water.
,Rationale: Placing the disconnected chest-tube end into sterile water temporarily recreates a
water seal and helps prevent atmospheric air from entering the pleural space. The nurse
should then obtain a new drainage system and reconnect it according to institutional
procedure. Routine clamping can cause dangerous pressure accumulation.
3.
Which assessment finding most strongly suggests that a client has developed a
pneumothorax?
A) Bilateral crackles and dependent edema
B) Productive cough with purulent sputum
C) Sudden unilateral diminished or absent breath sounds
D) Gradually increasing bilateral pedal edema
Correct Answer: Sudden unilateral diminished or absent breath sounds
Rationale: Pneumothorax involves air entering the pleural space and interfering with normal
lung expansion. Sudden unilateral reduction or absence of breath sounds is a classic finding,
particularly when accompanied by acute dyspnea or pleuritic pain. Crackles and peripheral
edema point toward other cardiopulmonary processes rather than an acute pneumothorax.
4.
A client is scheduled for thoracentesis. Which position should the nurse anticipate?
A) Supine with the legs elevated
B) Prone with the head turned to the side
C) Flat with both arms at the sides
D) Sitting upright and leaning forward with the arms supported
Correct Answer: Sitting upright and leaning forward with the arms supported
Rationale: Sitting upright and leaning forward helps widen the intercostal spaces and
facilitates access to the pleural cavity. The client should remain as still as possible during the
procedure to reduce the risk of injury. Positioning is particularly important because
movement can interfere with accurate needle placement.
5.
Before a video-assisted thoracic surgery procedure, which assessment is especially
important for establishing a respiratory baseline?
A) Auscultating breath sounds bilaterally
,B) Measuring abdominal girth
C) Testing visual acuity
D) Assessing bowel sounds only
Correct Answer: Auscultating breath sounds bilaterally
Rationale: VATS is a thoracic procedure, so a baseline respiratory assessment provides
information against which postoperative findings can be compared. Bilateral breath sounds
help identify preexisting abnormalities and later changes such as atelectasis or
pneumothorax. Abdominal, visual, and bowel assessments may be relevant generally but do
not establish the key respiratory baseline.
6.
A mechanically ventilated client triggers a high-pressure alarm. What should the nurse
assess first?
A) Whether the ventilator is unplugged
B) Whether the tubing is kinked or obstructed
C) Whether the oxygen cylinder is empty
D) Whether the client has stopped breathing
Correct Answer: Whether the tubing is kinked or obstructed
Rationale: A high-pressure alarm commonly indicates increased resistance to airflow. The
nurse should rapidly assess the client and then inspect the ventilator circuit for kinks,
secretions, biting, or other obstruction. Low-pressure alarms are more commonly associated
with disconnection or leaks, whereas high pressure suggests resistance.
7.
Which situation is most consistent with a low-pressure ventilator alarm?
A) Thick secretions obstructing the endotracheal tube
B) Bronchospasm increasing airway resistance
C) Disconnection or a leak in the ventilator circuit
D) The client biting the endotracheal tube
Correct Answer: Disconnection or a leak in the ventilator circuit
Rationale: A low-pressure alarm generally means the ventilator is not encountering the
expected resistance or pressure because delivered gas is escaping. Disconnection, cuff
, leakage, or circuit separation can cause this pattern. Obstruction, bronchospasm, and biting
increase airway resistance and are therefore more consistent with high-pressure alarms.
8.
A ventilated client suddenly becomes restless and oxygen saturation falls. Which action
should take priority?
A) Silence the alarm and leave the room.
B) Document the ventilator settings.
C) Wait for the next scheduled respiratory assessment.
D) Immediately assess the client and airway.
Correct Answer: Immediately assess the client and airway.
Rationale: Ventilator alarms must never be treated as merely equipment problems until the
client has been assessed. Acute restlessness and falling oxygen saturation may indicate
airway obstruction, tube displacement, pneumothorax, or another life-threatening problem.
The nurse should assess breathing, oxygenation, airway patency, and circulation while
troubleshooting the equipment.
9.
Which finding after thoracentesis requires the most immediate attention?
A) Mild soreness at the puncture site
B) Sudden dyspnea and decreased breath sounds
C) Small amount of localized bruising
D) Temporary anxiety about the procedure
Correct Answer: Sudden dyspnea and decreased breath sounds
Rationale: Sudden respiratory distress and decreased breath sounds following thoracentesis
may indicate an iatrogenic pneumothorax. This complication can impair ventilation and
become life-threatening if it progresses. Mild soreness, bruising, and anxiety may occur after
an invasive procedure but are generally less urgent than acute respiratory deterioration.
10.
A client with a chest tube has continuous bubbling in the water-seal chamber. What does
this finding most likely indicate?
A) Normal tidaling
B) Complete lung re-expansion
