NSG 4100 (AH III) Exam 3 | Advanced Cardiac
Perfusion & Hemodynamic Monitoring |
Questions and Correct Answers plus Rationales |
New Update 2026-2027 | Galen
Endotracheal Tubes and Tracheostomy
Question 1. The nurse caring for a patient with an endotracheal tube recognizes
several disadvantages of an endotracheal tube. What would the nurse recognize
as a disadvantage?
a. Cognition is decreased
b. Daily ABGs are necessary
c. Slight tracheal bleeding is anticipated
d. The cough reflex is depressed
Correct Answer: d. The cough reflex is depressed
Rationale: Endotracheal intubation bypasses the upper airway defenses and
depresses the cough reflex, increasing the risk for aspiration and infection.
Cognition is not directly decreased by the tube itself, daily ABGs are not routine,
and slight tracheal bleeding is not an expected disadvantage.
Question 2. What would the critical care nurse recognize as a condition that may
indicate a patient's need to have a tracheotomy?
a. A patient has a respiratory rate of 10 breaths/min
b. A patient required permanent ventilation
c. A patient exhibits symptoms of dyspnea
d. A patient has respiratory acidosis
Correct Answer: b. A patient required permanent ventilation
Rationale: A tracheotomy is indicated when a patient requires long-term or
permanent mechanical ventilation, as it provides a more stable airway, improves
,patient comfort, and reduces the risk of tracheal damage compared to prolonged
endotracheal intubation.
Question 3. The nurse is caring for a patient who is scheduled to have a
thoracotomy. When planning preoperative teaching, what information should
the nurse communicate to the patient?
a. How to milk the chest tubing
b. How to splint the incision when coughing
c. How to take prophylactic antibiotics correctly
d. How to manage the need for fluid restriction
Correct Answer: b. How to splint the incision when coughing
Rationale: Preoperative teaching for thoracotomy should include how to splint
the incision during coughing and deep breathing to reduce pain and prevent
atelectasis. Chest tube management is a nursing responsibility, and fluid
restriction is not routinely required.
Question 4. A nurse is educating a patient in anticipation of a procedure that will
require a water-sealed chest drainage system. What should the nurse tell the
patient and the family that this drainage system is used for?
a. Maintaining a positive chest-wall pressure
b. Monitoring pleural fluid osmolarity
c. Providing passive intrathoracic pressure
d. Removing excess air and fluid
Correct Answer: d. Removing excess air and fluid
Rationale: A water-sealed chest drainage system is used to remove air and fluid
from the pleural space while preventing air from re-entering, thereby restoring
negative intrathoracic pressure and allowing lung re-expansion.
,Question 5. A patient is exhibiting signs of a pneumothorax following
tracheostomy. The surgeon inserts a chest tube into the anterior chest wall.
What should the nurse tell the family is the primary purpose of this chest tube?
a. To remove air from the pleural space
b. To drain copious sputum secretions
c. To monitor bleeding around the lungs
d. To assist with mechanical ventilation
Correct Answer: a. To remove air from the pleural space
Rationale: In pneumothorax, air accumulates in the pleural space, causing lung
collapse. The chest tube is inserted to evacuate this air and allow the lung to re-
expand.
Question 6. A patient's plan of care specifies postural drainage. What action
should the nurse perform when providing this noninvasive therapy?
a. Administer the treatment with the patient in a high Fowler's or semi-Fowler's
position
b. Perform the procedure immediately following the patient's meals
c. Apply percussion firmly to bare skin to facilitate drainage
d. Assist the patient into a position that will allow gravity to move secretions
Correct Answer: d. Assist the patient into a position that will allow gravity to
move secretions
Rationale: Postural drainage uses gravity to drain secretions from specific lung
segments into the central airways. The patient is positioned with the affected lung
segment in a dependent position. It should not be performed immediately after
meals, and percussion is applied over clothing, not bare skin.
Question 7. While assessing the patient, the nurse observes constant bubbling in
the water-seal chamber of the patient's closed chest-drainage system. What
should the nurse conclude?
, a. The system is functioning normally
b. The patient has a pneumothorax
c. The system has a leak
d. The chest tube is obstructed
Correct Answer: c. The system has a leak
Rationale: Constant bubbling in the water-seal chamber indicates an air leak in
the system. Intermittent bubbling with respiration or coughing is normal. Constant
bubbling requires investigation and correction of the leak.
Question 8. The nurse has admitted a patient who is scheduled for a thoracic
resection. The nurse is providing preoperative teaching and is discussing several
diagnostic studies that will be required prior to surgery. Which study will be
performed to determine whether the planned resection will leave sufficient
functioning lung tissue?
a. Pulmonary function studies
b. Exercise tolerance tests
c. Arterial blood gas values
d. Chest x-ray
Correct Answer: a. Pulmonary function studies
Rationale: Pulmonary function studies assess lung volumes, capacities, and flow
rates. They help determine if the remaining lung tissue after resection will provide
adequate gas exchange.
Question 9. The nurse is discussing activity management with a patient who is
postoperative following thoracotomy. What instructions should the nurse give to
the patient regarding activity immediately following discharge?
a. Walk 1 mile 3-4 times a week
b. Use weights daily to increase arm strength
c. Walk on a treadmill 30 minutes daily
d. Perform shoulder exercises 5 times daily
Perfusion & Hemodynamic Monitoring |
Questions and Correct Answers plus Rationales |
New Update 2026-2027 | Galen
Endotracheal Tubes and Tracheostomy
Question 1. The nurse caring for a patient with an endotracheal tube recognizes
several disadvantages of an endotracheal tube. What would the nurse recognize
as a disadvantage?
a. Cognition is decreased
b. Daily ABGs are necessary
c. Slight tracheal bleeding is anticipated
d. The cough reflex is depressed
Correct Answer: d. The cough reflex is depressed
Rationale: Endotracheal intubation bypasses the upper airway defenses and
depresses the cough reflex, increasing the risk for aspiration and infection.
Cognition is not directly decreased by the tube itself, daily ABGs are not routine,
and slight tracheal bleeding is not an expected disadvantage.
Question 2. What would the critical care nurse recognize as a condition that may
indicate a patient's need to have a tracheotomy?
a. A patient has a respiratory rate of 10 breaths/min
b. A patient required permanent ventilation
c. A patient exhibits symptoms of dyspnea
d. A patient has respiratory acidosis
Correct Answer: b. A patient required permanent ventilation
Rationale: A tracheotomy is indicated when a patient requires long-term or
permanent mechanical ventilation, as it provides a more stable airway, improves
,patient comfort, and reduces the risk of tracheal damage compared to prolonged
endotracheal intubation.
Question 3. The nurse is caring for a patient who is scheduled to have a
thoracotomy. When planning preoperative teaching, what information should
the nurse communicate to the patient?
a. How to milk the chest tubing
b. How to splint the incision when coughing
c. How to take prophylactic antibiotics correctly
d. How to manage the need for fluid restriction
Correct Answer: b. How to splint the incision when coughing
Rationale: Preoperative teaching for thoracotomy should include how to splint
the incision during coughing and deep breathing to reduce pain and prevent
atelectasis. Chest tube management is a nursing responsibility, and fluid
restriction is not routinely required.
Question 4. A nurse is educating a patient in anticipation of a procedure that will
require a water-sealed chest drainage system. What should the nurse tell the
patient and the family that this drainage system is used for?
a. Maintaining a positive chest-wall pressure
b. Monitoring pleural fluid osmolarity
c. Providing passive intrathoracic pressure
d. Removing excess air and fluid
Correct Answer: d. Removing excess air and fluid
Rationale: A water-sealed chest drainage system is used to remove air and fluid
from the pleural space while preventing air from re-entering, thereby restoring
negative intrathoracic pressure and allowing lung re-expansion.
,Question 5. A patient is exhibiting signs of a pneumothorax following
tracheostomy. The surgeon inserts a chest tube into the anterior chest wall.
What should the nurse tell the family is the primary purpose of this chest tube?
a. To remove air from the pleural space
b. To drain copious sputum secretions
c. To monitor bleeding around the lungs
d. To assist with mechanical ventilation
Correct Answer: a. To remove air from the pleural space
Rationale: In pneumothorax, air accumulates in the pleural space, causing lung
collapse. The chest tube is inserted to evacuate this air and allow the lung to re-
expand.
Question 6. A patient's plan of care specifies postural drainage. What action
should the nurse perform when providing this noninvasive therapy?
a. Administer the treatment with the patient in a high Fowler's or semi-Fowler's
position
b. Perform the procedure immediately following the patient's meals
c. Apply percussion firmly to bare skin to facilitate drainage
d. Assist the patient into a position that will allow gravity to move secretions
Correct Answer: d. Assist the patient into a position that will allow gravity to
move secretions
Rationale: Postural drainage uses gravity to drain secretions from specific lung
segments into the central airways. The patient is positioned with the affected lung
segment in a dependent position. It should not be performed immediately after
meals, and percussion is applied over clothing, not bare skin.
Question 7. While assessing the patient, the nurse observes constant bubbling in
the water-seal chamber of the patient's closed chest-drainage system. What
should the nurse conclude?
, a. The system is functioning normally
b. The patient has a pneumothorax
c. The system has a leak
d. The chest tube is obstructed
Correct Answer: c. The system has a leak
Rationale: Constant bubbling in the water-seal chamber indicates an air leak in
the system. Intermittent bubbling with respiration or coughing is normal. Constant
bubbling requires investigation and correction of the leak.
Question 8. The nurse has admitted a patient who is scheduled for a thoracic
resection. The nurse is providing preoperative teaching and is discussing several
diagnostic studies that will be required prior to surgery. Which study will be
performed to determine whether the planned resection will leave sufficient
functioning lung tissue?
a. Pulmonary function studies
b. Exercise tolerance tests
c. Arterial blood gas values
d. Chest x-ray
Correct Answer: a. Pulmonary function studies
Rationale: Pulmonary function studies assess lung volumes, capacities, and flow
rates. They help determine if the remaining lung tissue after resection will provide
adequate gas exchange.
Question 9. The nurse is discussing activity management with a patient who is
postoperative following thoracotomy. What instructions should the nurse give to
the patient regarding activity immediately following discharge?
a. Walk 1 mile 3-4 times a week
b. Use weights daily to increase arm strength
c. Walk on a treadmill 30 minutes daily
d. Perform shoulder exercises 5 times daily
