MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
The patient is a 68-year-old man who has had shortness of breath (SOB) for the past 2 to 3
days. His past medical history includes a 40-packyear smoking history, COPD, and heart
failure. He reports that he became concerned when he woke from sleep because he could
not breathe. Your physical assessment reveals crackles in the lower lobes bilaterally. His
oxygen saturation (SpO2) is 84% without supplemental oxygen.
1. What are some areas of focus to assess as part of this patient's current history?
2. Who should you contact and why?
3. What are some factors that may affect gas exchange for this patient?
4. What additional referrals might be appropriate for this patient? - CORRECT ANSWERS 1.
What are some areas of focus to assess as part of this patient's current history?
Ask the patient to describe the onset of manifestations and any actions that exacerbate or
alleviate them. Ask about the paroxysmal nocturnal dyspnea (PND), if the patient
experiences orthopnea, and if so, how many pillows does he require in order to sleep. Ask
about his endurance, how far he can walk, and if his SOB has affected his ability to complete
his activities of daily living. Your history should also include all current over-the-counter and
prescription medications as well as herbal supplements. Does the patient use oxygen at
home? Is the patient working? If so, what type of work? Is there exposure to toxins? Does he
have a cough? You should inquire about his smoking history; if he is currently smoking, does
he have a plan to stop smoking? Smoking cessation counseling should be offered, and if
agreeable to the patient, drugs for smoking cessation should be considered. Ask about other
smokers in the home.
2. Who should you contact and why?
Contact this patient's primary health care provider and inform him or her of the patient's
oxygen saturation. Contact respiratory therapy for additional support with an appropriate
oxygen delivery method and to provide additional treatments as needed.
3. What are some factors that may affect gas exchange for this patient?
,MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
Decreased alveolar surface area (age related) is likely. Crackles may represent interstitial
edema, which will further reduce gas exchange. The patient's decreased endurance will
decrease gas exchange. Both his long-standing COPD and his existing heart failure negatively
affect his gas exchange.
4. What additional referrals might be appropriate for this patient?
This patient would benefit from a respiratory therapy consult for additional instruction with
breathing exercis
Your patient is the 68-year-old man from the previous Clinical Judgment Challenge who had
shortness of breath (SOB) for the past 2 to 3 days. His clinical condition deteriorated further,
requiring intubation. The health care provider orders a CT scan of the chest.
1. What are your responsibilities when preparing the patient for the CT scan?
2. Why is it important to monitor your patient using capnography?
3. A large fluid collection on the left side is found during the CT scan, and a thoracentesis is
planned. What are your responsibilities in preparing for and assisting with this procedure?
4. Your patient was extubated after the left thoracentesis. Within 12 hours he again develops
respiratory distress, decreased breath sounds, and a trachea that appears deviated to the
right. What is your assessment? - CORRECT ANSWERS Suggested responses:
1. What are your responsibilities when preparing the patient for the CT scan?
Determine patient sensitivity to intravenous contrast; allergies to iodine or shellfish; and
renal function, including baseline creatinine level.
2. Why is it important to monitor your patient using capnography?
Capnography is a noninvasive measurement of carbon dioxide levels. This information
provides information about CO2 production, alveolar function, and respiratory patterns. It
reflects changes in breathing effectiveness before hypoxia occurs.
,MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
3. A large fluid collection on the left side is found during the CT scan, and a thoracentesis is
planned. What are your responsibilities in preparing for and assisting with this procedure?
An explanation of the procedure to the patient, verify that a consent has been obtained,
determine allergies if a local anesthetic is to be used, and properly position the patient
(although this may be modified from a nonintubated patient's position).
4. Your patient was extubated after the left thoracentesis. Within 12 hours, he again
develops respiratory distress, decreased breath sounds, and a trachea that appears deviated
to the right. What is your assessment?
Pneumothorax, partial or complete, is a complication that can occur within 24 hours of a
thoracentesis. Tracheal deviation results as the thoracic structures are shifted away from the
collapsed lung.
Which client does the charge nurse on the medical unit assign to an RN who has floated
from the postanesthesia care unit (PACU)?
A. Client with allergic rhinitis scheduled for skin testing
B. Client with emphysema who needs teaching about pulmonary function testing
C. Client with pancreatitis who needs a preoperative chest x-ray
D. Client with pleural effusion who has had 1200 mL removed by thoracentesis - CORRECT
ANSWERS D
A nurse working in the PACU would be familiar with assessing vital signs and respiratory
status after procedures such as thoracentesis. Skin testing is performed in the outpatient
setting. Pulmonary function testing is not a procedure that requires PACU care. Although a
client with pancreatitis is seriously ill and would require a chest x-ray before undergoing
operative procedures, a nurse with a PACU monitoring skill set would not be required.
The RN and the LPN/LVN are working together to provide care for a client hospitalized with
dyspnea who requires all of these nursing actions. Which action is best accomplished by the
RN?
, MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
A. Administer the purified protein derivative for tuberculosis testing.
B. Assess vital signs and the puncture site after thoracentesis.
C. Monitor oxygen saturation using pulse oximetry every 4 hours.
D. Plan client and family teaching regarding upcoming pulmonary function testing. -
CORRECT ANSWERS D
Developing the teaching plan is the most complex of the skills listed and requires RN
education and licensure. Medication administration and monitoring of vital signs and client
status after procedures can be accomplished by the LPN/LVN. Monitoring of oxygen
saturation by pulse oximetry can be included in the vital signs assessment.
A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which
nursing task is best for the charge nurse to delegate to the experienced nursing assistant
working in the PACU?
A Assess breath sounds.
B Check gag reflex.
C Determine level of consciousness.
D Monitor blood pressure and pulse. - CORRECT ANSWERS D
A nursing assistant working in the PACU would have experience in taking client vital signs
after the client has had conscious sedation or anesthesia. Evaluating breath sounds and gag
reflex and determining level of consciousness require the skill and knowledge of a higher-
level provider.
The RN has received report about all of these clients. Which client needs the most
immediate assessment?
A Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry
B Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
The patient is a 68-year-old man who has had shortness of breath (SOB) for the past 2 to 3
days. His past medical history includes a 40-packyear smoking history, COPD, and heart
failure. He reports that he became concerned when he woke from sleep because he could
not breathe. Your physical assessment reveals crackles in the lower lobes bilaterally. His
oxygen saturation (SpO2) is 84% without supplemental oxygen.
1. What are some areas of focus to assess as part of this patient's current history?
2. Who should you contact and why?
3. What are some factors that may affect gas exchange for this patient?
4. What additional referrals might be appropriate for this patient? - CORRECT ANSWERS 1.
What are some areas of focus to assess as part of this patient's current history?
Ask the patient to describe the onset of manifestations and any actions that exacerbate or
alleviate them. Ask about the paroxysmal nocturnal dyspnea (PND), if the patient
experiences orthopnea, and if so, how many pillows does he require in order to sleep. Ask
about his endurance, how far he can walk, and if his SOB has affected his ability to complete
his activities of daily living. Your history should also include all current over-the-counter and
prescription medications as well as herbal supplements. Does the patient use oxygen at
home? Is the patient working? If so, what type of work? Is there exposure to toxins? Does he
have a cough? You should inquire about his smoking history; if he is currently smoking, does
he have a plan to stop smoking? Smoking cessation counseling should be offered, and if
agreeable to the patient, drugs for smoking cessation should be considered. Ask about other
smokers in the home.
2. Who should you contact and why?
Contact this patient's primary health care provider and inform him or her of the patient's
oxygen saturation. Contact respiratory therapy for additional support with an appropriate
oxygen delivery method and to provide additional treatments as needed.
3. What are some factors that may affect gas exchange for this patient?
,MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
Decreased alveolar surface area (age related) is likely. Crackles may represent interstitial
edema, which will further reduce gas exchange. The patient's decreased endurance will
decrease gas exchange. Both his long-standing COPD and his existing heart failure negatively
affect his gas exchange.
4. What additional referrals might be appropriate for this patient?
This patient would benefit from a respiratory therapy consult for additional instruction with
breathing exercis
Your patient is the 68-year-old man from the previous Clinical Judgment Challenge who had
shortness of breath (SOB) for the past 2 to 3 days. His clinical condition deteriorated further,
requiring intubation. The health care provider orders a CT scan of the chest.
1. What are your responsibilities when preparing the patient for the CT scan?
2. Why is it important to monitor your patient using capnography?
3. A large fluid collection on the left side is found during the CT scan, and a thoracentesis is
planned. What are your responsibilities in preparing for and assisting with this procedure?
4. Your patient was extubated after the left thoracentesis. Within 12 hours he again develops
respiratory distress, decreased breath sounds, and a trachea that appears deviated to the
right. What is your assessment? - CORRECT ANSWERS Suggested responses:
1. What are your responsibilities when preparing the patient for the CT scan?
Determine patient sensitivity to intravenous contrast; allergies to iodine or shellfish; and
renal function, including baseline creatinine level.
2. Why is it important to monitor your patient using capnography?
Capnography is a noninvasive measurement of carbon dioxide levels. This information
provides information about CO2 production, alveolar function, and respiratory patterns. It
reflects changes in breathing effectiveness before hypoxia occurs.
,MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
3. A large fluid collection on the left side is found during the CT scan, and a thoracentesis is
planned. What are your responsibilities in preparing for and assisting with this procedure?
An explanation of the procedure to the patient, verify that a consent has been obtained,
determine allergies if a local anesthetic is to be used, and properly position the patient
(although this may be modified from a nonintubated patient's position).
4. Your patient was extubated after the left thoracentesis. Within 12 hours, he again
develops respiratory distress, decreased breath sounds, and a trachea that appears deviated
to the right. What is your assessment?
Pneumothorax, partial or complete, is a complication that can occur within 24 hours of a
thoracentesis. Tracheal deviation results as the thoracic structures are shifted away from the
collapsed lung.
Which client does the charge nurse on the medical unit assign to an RN who has floated
from the postanesthesia care unit (PACU)?
A. Client with allergic rhinitis scheduled for skin testing
B. Client with emphysema who needs teaching about pulmonary function testing
C. Client with pancreatitis who needs a preoperative chest x-ray
D. Client with pleural effusion who has had 1200 mL removed by thoracentesis - CORRECT
ANSWERS D
A nurse working in the PACU would be familiar with assessing vital signs and respiratory
status after procedures such as thoracentesis. Skin testing is performed in the outpatient
setting. Pulmonary function testing is not a procedure that requires PACU care. Although a
client with pancreatitis is seriously ill and would require a chest x-ray before undergoing
operative procedures, a nurse with a PACU monitoring skill set would not be required.
The RN and the LPN/LVN are working together to provide care for a client hospitalized with
dyspnea who requires all of these nursing actions. Which action is best accomplished by the
RN?
, MED SURG GALEN EXAM #2 CHAPTERS
27,28,29,30,31 QUESTIONS AND ANSWERS
LATEST UPDATED 2024/2025 A COMPLETE EXAM
SOLUTION ALL ANSWERS 100% CORRECT
VERIFIED BEST RATED TO SCORE A+ FOR SUCCESS
A. Administer the purified protein derivative for tuberculosis testing.
B. Assess vital signs and the puncture site after thoracentesis.
C. Monitor oxygen saturation using pulse oximetry every 4 hours.
D. Plan client and family teaching regarding upcoming pulmonary function testing. -
CORRECT ANSWERS D
Developing the teaching plan is the most complex of the skills listed and requires RN
education and licensure. Medication administration and monitoring of vital signs and client
status after procedures can be accomplished by the LPN/LVN. Monitoring of oxygen
saturation by pulse oximetry can be included in the vital signs assessment.
A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which
nursing task is best for the charge nurse to delegate to the experienced nursing assistant
working in the PACU?
A Assess breath sounds.
B Check gag reflex.
C Determine level of consciousness.
D Monitor blood pressure and pulse. - CORRECT ANSWERS D
A nursing assistant working in the PACU would have experience in taking client vital signs
after the client has had conscious sedation or anesthesia. Evaluating breath sounds and gag
reflex and determining level of consciousness require the skill and knowledge of a higher-
level provider.
The RN has received report about all of these clients. Which client needs the most
immediate assessment?
A Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry
B Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes
