Test Bank for Clinical Manifestations and Assessment of
Respiratory Disease 8th Edition by Des Jardins
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 - Ans: A
Feedback:
Chest tubes and closed drainage systems are used to re-expand the lung involved and
to remove excess air, fluid, and blood. The primary purpose of a chest tube is not to
drain sputum secretions, monitor bleeding, or assist with mechanical ventilation.
The critical care nurse is precepting a new nurse on the unit. Together they are caring
for a patient who has a tracheostomy tube and is receiving mechanical ventilation. What
action should the critical care nurse recommend when caring for the cuff?
A) Deflate the cuff overnight to prevent tracheal tissue trauma.
B) Inflate the cuff to the highest possible pressure in order to prevent aspiration.
C) Monitor the pressure in the cuff at least every 8 hours
D) Keep the tracheostomy tube plugged at all times. - Ans: C
Feedback:
Cuff pressure must be monitored by the respiratory therapist or nurse at least every 8
hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by
using the minimal leak volume or minimal occlusion volume technique. Plugging is only
used when weaning the patient from tracheal support. Deflating the cuff overnight would
be unsafe and inappropriate. High cuff pressure can cause tissue trauma.
The acute medical nurse is preparing to wean a patient from the ventilator. Which
assessment parameter is most important for the nurse to assess?
,A) Fluid intake for the last 24 hours
B) Baseline arterial blood gas (ABG) levels
C) Prior outcomes of weaning
D) Electrocardiogram (ECG) results - Ans: B
Feedback:
Before weaning a patient from mechanical ventilation, it is most important to have
baseline ABG levels. During the weaning process, ABG levels will be checked to assess
how the patient is tolerating the procedure. Other assessment parameters are relevant,
but less critical. Measuring fluid volume intake and output is always important when a
patient is being mechanically ventilated. Prior attempts at weaning and ECG results are
documented on the patient's record, and the nurse can refer to them before the weaning
process begins.
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 of endotracheal tubes?
A) Cognition is decreased.
B) Daily arterial blood gases (ABGs) are necessary.
C) Slight tracheal bleeding is anticipated.
D) The cough reflex is depressed. - Ans: D
Feedback:
There are several disadvantages of an endotracheal tube. Disadvantages include
suppression of the patient's cough reflex, thickening of secretions, and depressed
swallowing reflexes. Ulceration and stricture of the larynx or trachea may develop, but
bleeding is not an expected finding. The tube should not influence cognition and daily
ABGs are not always required.
What would the critical care nurse recognize as a condition that may indicate a patient's
need to have a tracheostomy?
A) A patient has a respiratory rate of 10 breaths per minute.
B) A patient requires permanent ventilation.
,C) A patient exhibits symptoms of dyspnea.
D) A patient has respiratory acidosis. - Ans: B
Feedback:
A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of
oral and gastric secretions in the unconscious or paralyzed patient. Indications for a
tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of
dyspnea, or respiratory acidosis.
The medical nurse is creating the care plan of an adult patient requiring mechanical
ventilation. What nursing action is most appropriate?
A) Keep the patient in a low Fowler's position.
B) Perform tracheostomy care at least once per day.
C) Maintain continuous bedrest.
D) Monitor cuff pressure every 8 hours. - Ans: D
Feedback:
The cuff pressure should be monitored every 8 hours. It is important to perform
tracheostomy care at least every 8 hours because of the risk of infection. The patient
should be encouraged to ambulate, if possible, and a low Fowler's position is not
indicated.
5. 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 - Ans: B
Feedback:
Prior to thoracotomy, the nurse educates the patient about how to splint the incision with
the hands, a pillow, or a folded towel. The patient is not taught how to milk the chest
, tubing because this is performed by the nurse. Prophylactic antibiotics are not normally
used and fluid restriction is not indicated following thoracotomy.
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 positive chest-wall pressure
B) Monitoring pleural fluid osmolarity
C) Providing positive intrathoracic pressure
D) Removing excess air and fluid - Ans: D
Feedback:
Chest tubes and closed drainage systems are used to re-expand the lung involved and
to remove excess air, fluid, and blood. They are not used to maintain positive chest-wall
pressure, monitor pleural fluid, or provide positive intrathoracic pressure.
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 an air leak.
D) The chest tube is obstructed. - Ans: C
Feedback:
Constant bubbling in the chamber often indicates an air leak and requires immediate
assessment and intervention. The patient with a pneumothorax will have intermittent
bubbling in the water-seal chamber. If the tube is obstructed, the nurse should notice
that the fluid has stopped fluctuating in the water-seal chamber.
A patient recovering from thoracic surgery is on long-term mechanical ventilation and
becomes very frustrated when he tries to communicate. What intervention should the
nurse perform to assist the patient?
A) Assure the patient that everything will be all right and that remaining calm is the best
strategy.
Respiratory Disease 8th Edition by Des Jardins
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 - Ans: A
Feedback:
Chest tubes and closed drainage systems are used to re-expand the lung involved and
to remove excess air, fluid, and blood. The primary purpose of a chest tube is not to
drain sputum secretions, monitor bleeding, or assist with mechanical ventilation.
The critical care nurse is precepting a new nurse on the unit. Together they are caring
for a patient who has a tracheostomy tube and is receiving mechanical ventilation. What
action should the critical care nurse recommend when caring for the cuff?
A) Deflate the cuff overnight to prevent tracheal tissue trauma.
B) Inflate the cuff to the highest possible pressure in order to prevent aspiration.
C) Monitor the pressure in the cuff at least every 8 hours
D) Keep the tracheostomy tube plugged at all times. - Ans: C
Feedback:
Cuff pressure must be monitored by the respiratory therapist or nurse at least every 8
hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by
using the minimal leak volume or minimal occlusion volume technique. Plugging is only
used when weaning the patient from tracheal support. Deflating the cuff overnight would
be unsafe and inappropriate. High cuff pressure can cause tissue trauma.
The acute medical nurse is preparing to wean a patient from the ventilator. Which
assessment parameter is most important for the nurse to assess?
,A) Fluid intake for the last 24 hours
B) Baseline arterial blood gas (ABG) levels
C) Prior outcomes of weaning
D) Electrocardiogram (ECG) results - Ans: B
Feedback:
Before weaning a patient from mechanical ventilation, it is most important to have
baseline ABG levels. During the weaning process, ABG levels will be checked to assess
how the patient is tolerating the procedure. Other assessment parameters are relevant,
but less critical. Measuring fluid volume intake and output is always important when a
patient is being mechanically ventilated. Prior attempts at weaning and ECG results are
documented on the patient's record, and the nurse can refer to them before the weaning
process begins.
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 of endotracheal tubes?
A) Cognition is decreased.
B) Daily arterial blood gases (ABGs) are necessary.
C) Slight tracheal bleeding is anticipated.
D) The cough reflex is depressed. - Ans: D
Feedback:
There are several disadvantages of an endotracheal tube. Disadvantages include
suppression of the patient's cough reflex, thickening of secretions, and depressed
swallowing reflexes. Ulceration and stricture of the larynx or trachea may develop, but
bleeding is not an expected finding. The tube should not influence cognition and daily
ABGs are not always required.
What would the critical care nurse recognize as a condition that may indicate a patient's
need to have a tracheostomy?
A) A patient has a respiratory rate of 10 breaths per minute.
B) A patient requires permanent ventilation.
,C) A patient exhibits symptoms of dyspnea.
D) A patient has respiratory acidosis. - Ans: B
Feedback:
A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of
oral and gastric secretions in the unconscious or paralyzed patient. Indications for a
tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of
dyspnea, or respiratory acidosis.
The medical nurse is creating the care plan of an adult patient requiring mechanical
ventilation. What nursing action is most appropriate?
A) Keep the patient in a low Fowler's position.
B) Perform tracheostomy care at least once per day.
C) Maintain continuous bedrest.
D) Monitor cuff pressure every 8 hours. - Ans: D
Feedback:
The cuff pressure should be monitored every 8 hours. It is important to perform
tracheostomy care at least every 8 hours because of the risk of infection. The patient
should be encouraged to ambulate, if possible, and a low Fowler's position is not
indicated.
5. 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 - Ans: B
Feedback:
Prior to thoracotomy, the nurse educates the patient about how to splint the incision with
the hands, a pillow, or a folded towel. The patient is not taught how to milk the chest
, tubing because this is performed by the nurse. Prophylactic antibiotics are not normally
used and fluid restriction is not indicated following thoracotomy.
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 positive chest-wall pressure
B) Monitoring pleural fluid osmolarity
C) Providing positive intrathoracic pressure
D) Removing excess air and fluid - Ans: D
Feedback:
Chest tubes and closed drainage systems are used to re-expand the lung involved and
to remove excess air, fluid, and blood. They are not used to maintain positive chest-wall
pressure, monitor pleural fluid, or provide positive intrathoracic pressure.
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 an air leak.
D) The chest tube is obstructed. - Ans: C
Feedback:
Constant bubbling in the chamber often indicates an air leak and requires immediate
assessment and intervention. The patient with a pneumothorax will have intermittent
bubbling in the water-seal chamber. If the tube is obstructed, the nurse should notice
that the fluid has stopped fluctuating in the water-seal chamber.
A patient recovering from thoracic surgery is on long-term mechanical ventilation and
becomes very frustrated when he tries to communicate. What intervention should the
nurse perform to assist the patient?
A) Assure the patient that everything will be all right and that remaining calm is the best
strategy.
