Galen NSG 4100 Adult Health III Exam 3 | 143
Questions and Correct Answers with Rationales |
New 2026-2027 Update
Question 1. The nurse is preparing to care for a client who has returned to the
nursing unit following cardiac catheterization performed through the femoral
vessel. The nurse checks the health care provider's (HCP's) prescription and
plans to allow which client position or activity following the procedure?
1. Bed rest in high Fowler's position
2. Bed rest with bathroom privileges only
3. Bed rest with head elevation at 60 degrees
4. Bed rest with head elevation no greater than 30 degrees
Correct Answer: 4. Bed rest with head elevation no greater than 30 degrees
Rationale: After cardiac catheterization, the extremity into which the catheter
was inserted is kept straight for 4 to 6 hours. The client is maintained on bed rest
for 4 to 6 hours (time for bed rest may vary depending on the HCP's preference
and on whether a vascular closure device was used) and the client may turn from
side to side. The head is elevated no more than 30 degrees (although some HCPs
prefer a lower position or the flat position) until hemostasis is adequately
achieved.
Question 2. The nurse is assessing the functioning of a chest tube drainage
system in a client who has just returned from the recovery room following a
thoracotomy with wedge resection. Which are the expected assessment
findings? Select all that apply.
1. Excessive bubbling in the water seal chamber
2. Vigorous bubbling in the suction control chamber
, 3. Drainage system maintained below the client's chest
4. 50 mL of drainage in the drainage collection chamber
5. Occlusive dressing in place over the chest tube insertion site
6. Fluctuation of water in the tube in the water seal chamber during inhalation
and exhalation
Correct Answer: 3, 4, 5, 6
Rationale: The bubbling of water in the water seal chamber indicates air drainage
from the client and usually is seen when intrathoracic pressure is higher than
atmospheric pressure, and may occur during exhalation, coughing, or sneezing.
Excessive bubbling in the water seal chamber may indicate an air leak, an
unexpected finding. Fluctuation of water in the tube in the water seal chamber
during inhalation and exhalation is expected. An absence of fluctuation may
indicate that the chest tube is obstructed or that the lung has reexpanded and
that no more air is leaking into the pleural space. Gentle (not vigorous) bubbling
should be noted in the suction control chamber. A total of 50 mL of drainage is not
excessive in a client returning to the nursing unit from the recovery room.
Drainage that is more than 70 to 100 mL/hour is considered excessive and
requires notification of the health care provider. The chest tube insertion site is
covered with an occlusive (airtight) dressing to prevent air from entering the
pleural space. Positioning the drainage system below the client's chest allows
gravity to drain the pleural space.
Question 3. The nurse is assisting a health care provider with the removal of a
chest tube. The nurse should instruct the client to take which action?
1. Stay very still.
2. Exhale very quickly.
3. Inhale and exhale quickly.
4. Perform the Valsalva maneuver.
Correct Answer: 4. Perform the Valsalva maneuver.
,Rationale: When the chest tube is removed, the client is asked to perform the
Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is
quickly withdrawn, and an airtight dressing is taped in place. An alternative
instruction is to ask the client to take a deep breath and hold the breath while the
tube is removed.
Question 4. The nurse caring for a client with a pneumothorax and who has had
a chest tube inserted notes continuous gentle bubbling in the water seal
chamber. What action is most appropriate?
1. Do nothing, because this is an expected finding.
2. Check for an air leak, because the bubbling should be intermittent.
3. Increase the suction pressure so that the bubbling becomes vigorous.
4. Clamp the chest tube and notify the health care provider immediately.
Correct Answer: 2. Check for an air leak, because the bubbling should be
intermittent.
Rationale: Fluctuation with inspiration and expiration, not continuous bubbling,
should be noted in the water seal chamber. Intermittent bubbling may be noted if
the client has a known pneumothorax, but this should decrease as time goes on
and as the pneumothorax begins to resolve. Therefore, the nurse should check for
an air leak. If a wet chest drainage system is used, bubbling would be continuous
in the suction control chamber and not intermittent. In a dry system, there is no
bubbling. Increasing the suction pressure only increases the rate of evaporation of
water in the drainage system; in addition, increasing the suction can be harmful
and is not done without a specific prescription to do so if using a wet system. Dry
systems will allow for only a certain amount of suction to be applied; an orange
bellow will appear in the suction window, indicating that the proper amount of
suction has been applied. Chest tubes should be clamped only with a health care
provider's prescription.
, Question 5. The nurse is caring for a client with lung cancer and bone
metastasis. What signs and symptoms would the nurse recognize as indications
of a possible oncological emergency? Select all that apply.
1. Facial edema in the morning
2. Weight loss of 20 lb (9 kg) in 1 month
3. Serum calcium level of 12 mg/dL (3.0 mmol/L)
4. Serum sodium level of 136 mg/dL (136 mmol/L)
5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L)
6. Numbness and tingling of the lower extremities
Correct Answer: 1, 3, 6
Rationale: Oncological emergencies include sepsis, disseminated intravascular
coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord
compression, hypercalcemia, superior vena cava syndrome, and tumor lysis
syndrome. Blockage of blood flow to the venous system of the head resulting in
facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12
mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower
extremities could be a sign of spinal cord compression. Mild hypokalemia and
weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136
mmol/L) is a normal level.
Question 6. The nurse is assessing the respiratory status of a client who has
suffered a fractured rib. The nurse should expect to note which finding?
1. Slow, deep respirations
2. Rapid, deep respirations
3. Paradoxical respirations
4. Pain, especially with inspiration
Correct Answer: 4. Pain, especially with inspiration
Questions and Correct Answers with Rationales |
New 2026-2027 Update
Question 1. The nurse is preparing to care for a client who has returned to the
nursing unit following cardiac catheterization performed through the femoral
vessel. The nurse checks the health care provider's (HCP's) prescription and
plans to allow which client position or activity following the procedure?
1. Bed rest in high Fowler's position
2. Bed rest with bathroom privileges only
3. Bed rest with head elevation at 60 degrees
4. Bed rest with head elevation no greater than 30 degrees
Correct Answer: 4. Bed rest with head elevation no greater than 30 degrees
Rationale: After cardiac catheterization, the extremity into which the catheter
was inserted is kept straight for 4 to 6 hours. The client is maintained on bed rest
for 4 to 6 hours (time for bed rest may vary depending on the HCP's preference
and on whether a vascular closure device was used) and the client may turn from
side to side. The head is elevated no more than 30 degrees (although some HCPs
prefer a lower position or the flat position) until hemostasis is adequately
achieved.
Question 2. The nurse is assessing the functioning of a chest tube drainage
system in a client who has just returned from the recovery room following a
thoracotomy with wedge resection. Which are the expected assessment
findings? Select all that apply.
1. Excessive bubbling in the water seal chamber
2. Vigorous bubbling in the suction control chamber
, 3. Drainage system maintained below the client's chest
4. 50 mL of drainage in the drainage collection chamber
5. Occlusive dressing in place over the chest tube insertion site
6. Fluctuation of water in the tube in the water seal chamber during inhalation
and exhalation
Correct Answer: 3, 4, 5, 6
Rationale: The bubbling of water in the water seal chamber indicates air drainage
from the client and usually is seen when intrathoracic pressure is higher than
atmospheric pressure, and may occur during exhalation, coughing, or sneezing.
Excessive bubbling in the water seal chamber may indicate an air leak, an
unexpected finding. Fluctuation of water in the tube in the water seal chamber
during inhalation and exhalation is expected. An absence of fluctuation may
indicate that the chest tube is obstructed or that the lung has reexpanded and
that no more air is leaking into the pleural space. Gentle (not vigorous) bubbling
should be noted in the suction control chamber. A total of 50 mL of drainage is not
excessive in a client returning to the nursing unit from the recovery room.
Drainage that is more than 70 to 100 mL/hour is considered excessive and
requires notification of the health care provider. The chest tube insertion site is
covered with an occlusive (airtight) dressing to prevent air from entering the
pleural space. Positioning the drainage system below the client's chest allows
gravity to drain the pleural space.
Question 3. The nurse is assisting a health care provider with the removal of a
chest tube. The nurse should instruct the client to take which action?
1. Stay very still.
2. Exhale very quickly.
3. Inhale and exhale quickly.
4. Perform the Valsalva maneuver.
Correct Answer: 4. Perform the Valsalva maneuver.
,Rationale: When the chest tube is removed, the client is asked to perform the
Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is
quickly withdrawn, and an airtight dressing is taped in place. An alternative
instruction is to ask the client to take a deep breath and hold the breath while the
tube is removed.
Question 4. The nurse caring for a client with a pneumothorax and who has had
a chest tube inserted notes continuous gentle bubbling in the water seal
chamber. What action is most appropriate?
1. Do nothing, because this is an expected finding.
2. Check for an air leak, because the bubbling should be intermittent.
3. Increase the suction pressure so that the bubbling becomes vigorous.
4. Clamp the chest tube and notify the health care provider immediately.
Correct Answer: 2. Check for an air leak, because the bubbling should be
intermittent.
Rationale: Fluctuation with inspiration and expiration, not continuous bubbling,
should be noted in the water seal chamber. Intermittent bubbling may be noted if
the client has a known pneumothorax, but this should decrease as time goes on
and as the pneumothorax begins to resolve. Therefore, the nurse should check for
an air leak. If a wet chest drainage system is used, bubbling would be continuous
in the suction control chamber and not intermittent. In a dry system, there is no
bubbling. Increasing the suction pressure only increases the rate of evaporation of
water in the drainage system; in addition, increasing the suction can be harmful
and is not done without a specific prescription to do so if using a wet system. Dry
systems will allow for only a certain amount of suction to be applied; an orange
bellow will appear in the suction window, indicating that the proper amount of
suction has been applied. Chest tubes should be clamped only with a health care
provider's prescription.
, Question 5. The nurse is caring for a client with lung cancer and bone
metastasis. What signs and symptoms would the nurse recognize as indications
of a possible oncological emergency? Select all that apply.
1. Facial edema in the morning
2. Weight loss of 20 lb (9 kg) in 1 month
3. Serum calcium level of 12 mg/dL (3.0 mmol/L)
4. Serum sodium level of 136 mg/dL (136 mmol/L)
5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L)
6. Numbness and tingling of the lower extremities
Correct Answer: 1, 3, 6
Rationale: Oncological emergencies include sepsis, disseminated intravascular
coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord
compression, hypercalcemia, superior vena cava syndrome, and tumor lysis
syndrome. Blockage of blood flow to the venous system of the head resulting in
facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12
mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower
extremities could be a sign of spinal cord compression. Mild hypokalemia and
weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136
mmol/L) is a normal level.
Question 6. The nurse is assessing the respiratory status of a client who has
suffered a fractured rib. The nurse should expect to note which finding?
1. Slow, deep respirations
2. Rapid, deep respirations
3. Paradoxical respirations
4. Pain, especially with inspiration
Correct Answer: 4. Pain, especially with inspiration
