NSG 4100 (AH III) EXAM 3
The nurse caring for a patient with and 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
What would the critical care nurse recognize as a condition that may indicate a pt'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 sx of dyspnea
d. a patient has respiratory acidosis
The nurse is caring for a pt who is scheduled to have a thoracotomy. When planning
preoperative teaching, what info should the nurse communicate to the pt?
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
A nurse is educating a pt in anticipation of a procedure that will require a water
sealed chest drainage system. What should the nurse tell the pt 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
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
,A patient's plan of care specifies postural drainage. What action should the nurse
perform when providing this noninvasive therapy?
a. administer the tx w/ the pt in a high Fowler's or semi-fowlers position
b. perform the procedure immediately following the pt's meals
c. apply percussion firmly to bare skin to facilitate drainage
d. assist the pt into a position that will allow gravity to move secretions
While assessing the pt, the nurse observes constant bubbling in the water-seal
chamber of the pt's closed chest-drainage system. What should the Nurs conclude?
a. the system is functioning normally
b. pt has a pneumothorax
c. system has a leak
d. chest tube is obstructed
The nurse has admitted a pt 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
panned resection will leave sufficient functioning lung tissue?
a. pulmonary function studies
b. exercise tolerance tests
c. arterial blood gas values
d. chest x-ray
, The nurse is discussing activity management w/ a pt who is postoperative following
thoracotomy. What instructions should the nurse give to the pt regarding activity
immediately following discharge?
a. walk 1 mile 3-4x a week
b. use wights daily to increase arm strength
c. walk on a treadmill 30min daily
d. perform shoulder exercises 5x daily
The OR nurse is setting up a water-seal chest drainage system for a pt who has just
had a thoracotomy. The nurse knows that the amount of suction in the system is
determined by the water level. At what suction level should the nurse set the system?
a. 20 cm H2O
b. 15 cm H2O
c. 10 cm H2O
d. 5 cm H2O
The nurse is caring for a client w/ and endotracheal tube who is on a ventilator. When
assessing the client, the nurse knows to maintain what cuff pressure to maintain
appropriate pressure on the tracheal wall?
a. between 10-15 mm Hg
b. between 15-20 mm Hg
c. between 20-25 mm Hg
The nurse caring for a patient with and 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
What would the critical care nurse recognize as a condition that may indicate a pt'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 sx of dyspnea
d. a patient has respiratory acidosis
The nurse is caring for a pt who is scheduled to have a thoracotomy. When planning
preoperative teaching, what info should the nurse communicate to the pt?
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
A nurse is educating a pt in anticipation of a procedure that will require a water
sealed chest drainage system. What should the nurse tell the pt 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
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
,A patient's plan of care specifies postural drainage. What action should the nurse
perform when providing this noninvasive therapy?
a. administer the tx w/ the pt in a high Fowler's or semi-fowlers position
b. perform the procedure immediately following the pt's meals
c. apply percussion firmly to bare skin to facilitate drainage
d. assist the pt into a position that will allow gravity to move secretions
While assessing the pt, the nurse observes constant bubbling in the water-seal
chamber of the pt's closed chest-drainage system. What should the Nurs conclude?
a. the system is functioning normally
b. pt has a pneumothorax
c. system has a leak
d. chest tube is obstructed
The nurse has admitted a pt 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
panned resection will leave sufficient functioning lung tissue?
a. pulmonary function studies
b. exercise tolerance tests
c. arterial blood gas values
d. chest x-ray
, The nurse is discussing activity management w/ a pt who is postoperative following
thoracotomy. What instructions should the nurse give to the pt regarding activity
immediately following discharge?
a. walk 1 mile 3-4x a week
b. use wights daily to increase arm strength
c. walk on a treadmill 30min daily
d. perform shoulder exercises 5x daily
The OR nurse is setting up a water-seal chest drainage system for a pt who has just
had a thoracotomy. The nurse knows that the amount of suction in the system is
determined by the water level. At what suction level should the nurse set the system?
a. 20 cm H2O
b. 15 cm H2O
c. 10 cm H2O
d. 5 cm H2O
The nurse is caring for a client w/ and endotracheal tube who is on a ventilator. When
assessing the client, the nurse knows to maintain what cuff pressure to maintain
appropriate pressure on the tracheal wall?
a. between 10-15 mm Hg
b. between 15-20 mm Hg
c. between 20-25 mm Hg
