NSG 4100 (AH III) Exam 3 Best Resource before Exam with 100% Researched Answers.

NSG 4100 (AH III) Exam 3 Best Resource before Exam with 100% Researched Answers. The nurse is caring for a pt who is scheduled for a lobectomy for diagnosis of lung cancer. Which assisting with a subclavian vein central line insertion, the nurse notes the pt's oxygen saturation rapidly dropping. The pt c/o SOB and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the present of a pneumothorax include what? a. diminished or absent breath sounds on the affected side b. paradoxical chest wall movement w/ respirations c. sudden loss of consciousness d. muddled heart sounds - ANSWERS A An x-ray of a trauma pt reveals rib fractures and the pt is dx w/ a small flail chest injury. Which intervention should the nurse include in the pt's plan of care? a. suction the pt's airway secretions b. immobilize the ribs w/ an abdominal binder c. prepare the pt for surgery d. immediately sedate and intubate the pt - ANSWERS A The nurse is assessing an adult pt following a MVA. The nurse observes that the pt has an increased use of accessory muscles and is complaining of chest pain and SOB. The nurse should recognize the possibility of what condition? a. Pneumothorax b. anxiety c. acute bronchitis d. aspiration - ANSWERS A The nurse is caring for a pt suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this ds to differentiate the pt's sx from those of a cardiac etiology? a. Carboxyhemoglobin level b. Brain natriuretic peptide (BNP) level c. C-reactive protein (CRP) level d. complete blood count - ANSWERS B The school nurse is presenting a class on smoking cessation at the high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response to risk for lung cancer in smokers is most accurate? a. the younger you are when you start smoking, the higher your risk of lung cancer b. the risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays c. the risk for lung cancer is determines mostly by what type of cigarettes you smoke d. the risk for lung cancer depends on the other risk factors for cancer that you have - ANSWERS A The nurse is assessing a pt who has a 35 pack-year hx of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the pt for further assessment? a. lately, I have this cough that just never seems to go away b. I find that I don't have nearly the stamina that I used to c. I seem to get nearly every cold that goes around my workplace d. I never used to have any allergies, but now I think im developing allergies to dust and pet hair - ANSWERS A What would the critical care nurse recognize as a condition that may indicate a pt's need to have a tracheotomy? a. a pt has a respiratory rate of 10 breaths/min b. a pt required permanent ventilation c. a pt exhibits sx of dyspnea d. a pt has respiratory acidosis - ANSWERS B 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 - ANSWERS B 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 - ANSWERS D A pt 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 - ANSWERS A A pt'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 - ANSWERS D While assessing the pt, the nurse observes constant bubbling in the water-seal chamber of the pt's closed chest-drinagae 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 - ANSWERS C 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 - ANSWERS A 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 - ANSWERS D 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 - ANSWERS A 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