Lower Respiratory Disorders (Med-Surg EAQs)

Which size chest tube would the nurse have available for insertion for a patient who needs to have air drained from the chest? 1. 14F 2. 26F 3. 36F 4. 40F

1. 14F (Small tubes having the size in the range of 12F to 24F are used to drain air from the patient's chest. Medium tubes in the range of 24F to 36F are used for draining fluid from the patient's chest. Large tubes ranging from 36F to 40F are used for draining blood from the patient's chest.)

Which complication does the nurse expect when a patient with fractured ribs is wearing a binder on the chest? 1. Atelectasis 2. Chylothorax 3. Hemopneumothorax 4. Pulmonary embolism

1. Atelectasis (Applying a binder on fractured ribs can reduce the chest expansion and retain secretions. Therefore the patient will have the risk of atelectasis. Chylothorax is complication of chest trauma, which results from disruption of the thoracic duct. Hemopneumothorax is the presence of blood in the pleural cavity due to chest trauma. Pulmonary embolism is a blockage of pulmonary a blood vessel due to thrombus formation; this complication is not associated with application of a binder.)

Which condition in a patient with chest trauma requires treatment of positive pressure ventilation? 1. Flail chest 2. Cardiac tamponade 3. Hemopneumothorax 4. Tension pneumothorax

1. Flail chest (Flail chest results in loss of chest stability due to fracture of the ribs. The patient with loss of chest stability requires positive pressure ventilation to ensure proper respiration. The nurse performs needle decompression to treat the cardiac tamponade effectively. The patient with hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage, and positive pressure ventilation aggravates the patient's condition.)

Which statement is true regarding a water-seal chamber? 1. It contains 2 cm of water 2. It acts as a two-way valve 3. It receives fluid and air from the pleural space 4. It applies suction to the chest drainage system

1. It contains 2 cm of water (The water-seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system.)

Which type of surgery involves the removal of one lobe of lung? 1. Lobectomy 2. Pneumonectomy 3. Wedge resection 4. Segmental resection

1. Lobectomy (A lobectomy is a type of chest surgery that involves removal of one lobe of lung. A pneumonectomy is a type of chest surgery that involves removal of entire lung. A wedge resection is a type of surgery that involves removal of only a small, localized lesion. A segmental resection is a type of surgery that involves removal of one or more lung segments.)

Which outcome does the nurse expect from administering patient-controlled analgesia (PCA) to the patient who has undergone thoracotomy? Select all that apply 1. The patient will have effective cough 2. The patient will be able to take deep breaths 3. The patient will have reexpansion of the lungs 4. The patient will have reduced pulmonary edema 5. The patient will be able to move the arm on the operative side

1. The patient will have effective cough 2. The patient will be able to take deep breaths 5. The patient will be able to move the arm on the operative side (Thoracotomy is a painful procedure and involves cutting respiratory muscles during the surgery. Therefore the nurse administers patient-controlled analgesia (PCA) to alleviate pain. This will help the patient to cough effectively because there is a reduction in pain. Due to pain reduction, the strain on the lungs is reduced during breathing and the patient will be able to take deep breaths more easily. PCA will relieve pain and ease the movement of arm on the operative side. The chest tube placed on the chest after thoracotomy helps lung expansion. The nurse administers diuretics to relieve pulmonary edema.)

Which wound is described as a penetrating trauma on the chest wall? 1. Wound caused by gunshot 2. Wound caused bu crush injury 3. Wound caused by pedestrian accident 4. Wound caused by motor vehicle accident

1. Wound caused by gunshot (The wound caused by a gunshot is a penetrating trauma because it is an open injury into which a foreign object enters into the body. A wound caused by a motor vehicle accident, a crush injury, or a pedestrian accident are blunt injuries.)

Which intervention does the nurse perform 30 minutes before removing a chest tube from a patient? 1. Instruct the patient to eat 2. Administer pain medications to the patient 3. Instruct the patient to perform the Valsalva maneuver 4. Apply an airtight dressing over the chest tube insertion site

2. Administer pain medications to the patient (While removing the chest tube, the patient may have pain; therefore, the nurse administers pain medication 30 minutes before the procedure. The nurse does not instruct the patient to eat before the procedure, because eating may cause nausea. The nurse applies an airtight dressing after removing the chest tube to prevent air from entering into the pleural space. The nurse instructs the patient to perform the Valsalva maneuver during the procedure to ease the process of tube removal.)

Which surgical procedure involves the removal of a part of pleura in the body? 1. Pleurodesis 2. Pleurectomy 3. Pleural biopsy 4. Thoracentesis

2. Pleurectomy (Pleurectomy is a procedure that involves in the removal of a part of pleura that has tumor or is damaged. Pleurodesis is the surgical procedure that helps in adhesion of visceral and parietal pleura in the patient who has pneumothorax. Pleural biopsy is a procedure in which a sample of pleural cell is examined for tumors. Thoracentesis is a procedure that is performed to drain the fluid from the pleural space.)

What is the most evident symptom of flail chest in an unconscious patient? 1. Cyanosis 2. Shallow respiration 3. Distension of neck vein 4. Symmetric movement of thorax

2. Shallow respiration (An unconscious patient who has fractures of consecutive ribs will have rapid and shallow respirations. Cyanosis may occur in a patient with impaired respiration; however, it is not an evident symptom of flail chest. The patient with flail chest will not have edema, so distension of the neck is not apparent. The patient with flail chest will have asymmetric movement of the thorax due to poor air movement.)

While monitoring a patient who is on a wet chest drainage system, the nurse covers the suction control chamber with a muffler. What is the reason for this intervention? 1. To reduce the pleural air leak 2. To reduce the noise of the chamber 3. To increase the bubbling of the water 4. To increase the suction from the chamber

2. To reduce the noise of the chamber (The suction chamber is covered with a muffler because the continuous boiling is noisy and it may disturb the patient. The absence of bubbles in the chamber will reduce the pleural air leak but closing the chamber with a muffler will not. The muffler will reduce evaporation but will not increase the bubbling. The suction from the chamber is increased when slight bubbles form in the water.)

The patient has sustained multiple injuries after a motor vehicle accident. Which is the priority nursing assessment in order to minimize the patient's greatest risk? 1. Pain and dyspnea 2. Tracheal deviation 3. Rapid thready pulse 4. Bruising on left flank

2. Tracheal deviation (The nurse knows to check the patient's airway, breathing, and circulation. The priority assessment is to check for tracheal deviation with potential loss of airway since an inability to breathe poses the greatest threat to the patient's life. Circulatory compromise is identified with a rapid thready pulse, and possible abdominal bleeding can be indicated by bruising to the left flank; checking these can follow checking for tracheal deviation. Pain and dyspnea may be caused by the other problems; this assessment is also a lower priority than checking for a clear airway.)

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing interventions? 1. Water-seal chamber has 5 cm of water 2. No new drainage in collection chamber 3. Chest tube with a loose-fitting dressing 4. Small pneumothorax at CT insertion site

3. Chest tube with a loose-fitting dressing (If the dressing at the CT insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water, but having more water will not contribute to an air leak, and it should not be drained from the CDS. No new drainage does not indicate an air leak, but may indicate the CT is no longer needed. If there is a pneumothorax, the chest tube should remove the air. )

A patient with a spontaneous pneumothorax has a chest tube that is attached to a closed drainage system. The drainage unit is not attached to suction. The water level in the water-seal chamber is fluctuating. What action should the nurse take? 1. Notifying the primary health care provider immediately 2. Decreasing the amount of water in the water-seal chamber 3. Continuing to monitor and document the respiratory status 4. Clamping the chest tube as close as possible to the insertion site

3. Continuing to monitor and document the respiratory status (In a closed drainage system (not in a suction system) the fluid in the water-seal chamber rises when the patient inhales and falls when the patient exhales; this is a normal finding. The absence of fluctuations may indicate an obstruction in the system. The nurse must continually check the function of the closed drainage system and assess respiratory status at least every four hours. There is no need to notify the primary health care provider or decrease the amount of water in the water-seal chamber, because the chest tube system is functioning normally. The chest tube should not be clamped unless the nurse is directed to do so by the primary health care provider because doing so could cause a tension pneumothorax.)

The nurse is assessing a patient who has a closed chest tube drainage system attached to a water-seal chamber. The nurse notes that the tidaling has stopped. What is the priority intervention by the nurse? 1. Continue to monitor the patient 2. Check all connections for a leak in the system 3. Investigate the chest tube for possible occlusion 4. Lower the drainage collector further from the chest

3. Investigate the chest tube for possible occlusion (Normal fluctuation of the water within the water-seal chamber is called tidaling. This up and down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. Investigate any sudden cessation of tidaling because this may signify an occluded chest tube. Monitoring the patient will occur simultaneously. The nurse could check all connections for a leak, but the most common cause is occlusion, so this would occur after checking for an occlusion. The drainage collector is likely already in a low position.)

What is the reason that the nurse, while assisting with insertion of a chest tube, positions the patient with the arm raised above the head on the affected side? 1. To minimize pain 2. To reduce the risk of injury 3. To expose the midaxillary area 4. To avoid the intercostal nerves

3. To expose the midaxillary area (The midaxillary area is the standard site for insertion of a chest tube. Therefore the nurse will position the patient with the arm raised above the head on the affected side to expose the midaxillary area. Analgesics will be given to the patient to minimize pain. The patient's head will be elevated to reduce the risk of injury. The chest tube will be advanced up over the over the top of the rib to avoid the intercostal nerves.)

A patient has a sucking chest wound due to a surgical thoracotomy. Which type of pneumothorax does the nurse expect? 1. Tension pneumothorax 2. Iatrogenic pneumothorax 3. Traumatic pneumothorax 4. Spontaneous pneumothorax

3. Traumatic pneumothorax (A penetrating wound of the chest may be referred to as a sucking chest wound because air enters the pleural space during inspiration through the chest wall. Surgical thoracotomy can cause sucking chest wounds and result in traumatic pneumothorax. Tension pneumothorax is the condition associated with accumulation of air in pleural space, resulting in lung compression. Iatrogenic pneumothorax is trauma to the chest wall that occurs during a medical procedure such as thoracentesis. Spontaneous pneumothorax is chest wall trauma that is associated with rupture of small blebs.)

A patient has a chest tube inserted to treat a spontaneous pneumothorax. Which observation causes the nurse to conclude that the water-seal chamber of the closed chest drainage system is functioning properly? 1. Gentle bubbling in the suction chamber 2. Patient tolerating mild shortness of breath 3. Water-seal chamber level fluctuating with respirations 4. The presence of bloody drainage in the water-seal chamber

3. Water-seal chamber level fluctuating with respirations (The water-seal chamber level fluctuates with respirations as a result of the restoration of negative pressure within the thoracic cavity. Gentle bubbling in the suction chamber indicates a possible air leak. New-onset of shortness of breath in a patient with a chest tube requires further assessment. The water-seal chamber should not contain blood; this finding indicates that the chest tube drainage system may have been knocked onto its side and should be replaced.)

The nurse provides care to a trauma victim. Which clinical manifestation most suggests a pneumothorax? 1. Inspiratory crackles 2. Pronounced crackles 3. Dullness on percussion 4. Absence of breath sounds

4. Absence of breath sounds (A pneumothorax indicates that one of the lungs has collapsed and is not functioning. On auscultation no sounds of air movement will be heard. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Dullness may be a finding on percussion over the area of the pneumothorax, but an absence of breath sounds is the definitive finding.)

The diagnostic reports of a patient indicate that the patient has chylothorax. The primary health care provider has prescribed octreotide. What outcome does the nurse expect after treatment? 1. Adequate hydration 2. Adequate pain control 3. Reduced risk of hypoxemia 4. Reduced flow of lymphatic fluid

4. Reduce flow of lymphatic fluid (Chylothorax is a type of chest injury that is associated with accumulation of fluid in the pleural space. Octreotide acts like the natural hormone, somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into pleural space. The patient with chylothorax will not need dehydration and intravenous fluids or diuretics would increase hydration. The nurse administers analgesia for adequate pain control. Octreotide does not relieve the accumulation of alveoli. Therefore the patient will not have effective treatment for hypoxemia.)

The nurse is assessing a young male patient who came to the emergency department complaining of sudden shortness of breath. He has no other visible problems. The nurse notes that, upon auscultation, there are no breath sounds on the right upper lobe of the lung. The nurse suspects that the patient has which of these conditions? 1. Tension pneumothorax 2. Iatrogenic pneumothorax 3. Traumatic pneumothorax 4. Spontaneous pneumothorax

4. Spontaneous pneumothorax (A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs because of the rupture of small blebs (air-filled blisters) located on the apex of the lung. These blebs can occur in healthy, young individuals, especially tall, thin males. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. Tension pneumothorax can occur with mechanical ventilation and resuscitative efforts. Iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. Traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma.)

A patient comes to the emergency room presenting with dyspnea, tachycardia, violent agitation, tracheal deviation, neck vein distension, and hyperresonance to percussion. Which condition should the nurse suspect? 1. Flail chest 2. Hemothorax 3. Cardiac tamponade 4. Tension pneumothorax

4. Tension pneumothorax (Tension pneumothorax is the result of increased air in the pleural space; it causes shifting of bodily organs and an increase in intrathoracic pressure. The patient usually presents with cyanosis, air hunger, violent agitation, tracheal deviation, neck vein distension, and hyperresonance to percussion. Hemothorax is an accumulation of blood in the pleural space; the patient usually presents with dyspnea, diminished breath sounds, dullness to percussion, and shock, depending on blood loss. Flail chest is a fracture of two or more ribs; the patient presents with paradoxical movement of the chest wall and respiratory distress. Cardiac tamponade occurs when blood collects in the pericardial sac; the patient presents with muffled, distant heart sounds, hypotension, neck vein distension, and increased central venous pressure.)

A nurse is monitoring the chest drainage system of a patient and finds that bubbling has increased. The nurse then marks the whole tube with the numbers 1, 2, 3, 4, and 5 at increments and clamps the tube methodically. The nurse finds that the leak stopped when the clamps were between 3 and 4. What does this indicate? 1. The air leak was from the patient's chest 2. The air leak was from the tube between points 1 and 2 3. The air leak was from the tube between points 4 and 5 4. The air leak was from the tube between points 3 and 4

4. The air leak was from the tube between points 3 and 4 (Whenever the bubbling increases, the nurse should suspect an air leak. To look for the point of leak, the nurse should clamp the tube to the chest and see if it is from the patient's chest. Then the nurse should mark the tube and move the clamps methodically away from the chest. If the leak stops at a particular point, this indicates that the leak was between these two points. Therefore the air leak was from the tube between points 3 and 4.)

Which type of surgery allows the surgeon to manipulate instruments passed into the pleural space? 1. Decortication 2. Segmental resection 3. Exploratory thoracotomy 4. Video-assisted thoracoscopic surgery

4. Video-assisted thoracoscopic surgery (Video-assisted thoracoscopic surgery allows the surgeon to manipulate instruments passed into pleural space. Decortication, segmental resection, and exploratory thoracotomy do not allow the surgeon to manipulate instruments passed into pleural space.)