NMNC 4335 - Gas Exchange

The nurse is caring for a client who experienced a crushing chest injury. A chest tube is inserted. Which observation indicates a desired response to this treatment? 1 Increased breath sounds 2 Increased respiratory rate 3 Crepitus detected on palpation of the chest 4 Constant bubbling in the drainage collection chamber

1 Increased breath sounds

Which action will the nurse take to check for subcutaneous emphysema in a client with a chest tube? 1 Palpate around the tube insertion sites for crepitus. 2 Auscultate the breath sounds for crackles and atelectasis. 3 Observe the client for the presence of a barrel-shaped chest. 4 Compare the length of inspiration with the length of expiration.

1 Palpate around the tube insertion sites for crepitus.

A client anticipates removal of his or her chest tube with angst. Which diagnostic procedure does the nurse discuss when determining when to remove a client's chest tube? 1 The client tolerates disconnection from the chest tube's drainage system for 24 hours. 2 A chest x-ray examination occurs before removal to determine lung reexpansion. 3 A required arterial blood gas occurs to determine sustained oxygenation status. 4 The nurse will sedate the client 30 minutes before the scheduled procedure.

2 A chest x-ray examination occurs before removal to determine lung reexpansion.

Which action would the nurse take to determine patency of the chest tube and closed chest drainage system in a client after left lower lobectomy? 1 Milk the chest tube toward the drainage unit. 2 Check the amount of bubbling in the suction control chamber. 3 Observe for fluctuations of the fluid in the water-seal chamber. 4 Assess for extent of chest expansion in relation to breath sounds.

3 Observe for fluctuations of the fluid in the water-seal chamber.

Which finding best indicates that the chest tube for a client with a pneumothorax may be discontinued? 1 Clear breath sounds heard in both lungs 2 Oxygen saturation reading is higher than 90% 3 Absence of bubbling in the water-seal chamber 4 Full re-expansion of the lungs seen on chest x-ray

4 Full re-expansion of the lungs seen on chest x-ray

Which actions will the nurse take when caring for a client with a chest tube in place after thoracotomy? SATA 1 Administer prescribed analgesic medications. 2 Check around chest tube insertion site for crepitus. 3 Clamp the chest tube before the client ambulates. 4 Add fluid to the suction control chamber as needed. 5 Milk the tubing toward the collection chamber. 6 Check for air bubbling in the water-seal chamber.

1 Administer prescribed analgesic medications. 2 Check around chest tube insertion site for crepitus. 4 Add fluid to the suction control chamber as needed. 6 Check for air bubbling in the water-seal chamber.

When caring for a client who has hemopneumothorax and a chest tube, which prescribed action by the health care provider would the nurse question? 1 Autotransfuse the blood in the collection chamber after 6 hours. 2 Disconnect the drainage system from suction to ambulate the client. 3 Add sterile water to the suction control chamber to maintain 20 cm of suction. 4 Use a dressing impregnated with petroleum jelly around the chest tube insertion site.

1 Autotransfuse the blood in the collection chamber after 6 hours.

When caring for a client after a thoracotomy, which action would the nurse take to keep the chest tube and closed chest drainage system patent? 1 Position the drainage system below the level of the client's heart. 2 Empty the collection chamber and measure contents every 12 hours. 3 Assure that a daily chest x-ray is done to check chest tube position. 4 Keep the client on bed rest until the chest tube is discontinued.

1 Position the drainage system below the level of the client's heart.

When a client who has a chest tube after thoracotomy reports sharp chest pain at the chest tube and refuses to take deep breaths, which action by the nurse is best? 1 Assist the client to sit up in a chair. 2 Administer prescribed pain medications. 3 Educate about the reason for deep breathing. 4 Explain that some pain is normal with a chest tube.

2 Administer prescribed pain medications.

A client has chest tubes attached to a chest tube drainage system. Which intervention would the nurse perform when caring for this client? 1 Clamp the chest tubes when suctioning. 2 Palpate the surrounding area for crepitus. 3 Change the dressing daily using aseptic technique. 4 Empty the drainage chamber at the end of the shift.

2 Palpate the surrounding area for crepitus.

A client with a chest tube is to be transported via a stretcher. When transporting the client, what would the nurse do? 1 Keep collection device attached to mechanical suction 2 Keep chest tube clamped distal to the water-seal chamber 3 Keep collection device below the level of the client's chest 4 Keep chest tube end covered with sterile gauze pads taped to the client

3 Keep collection device below the level of the client's chest

A client has a closed chest drainage system in place. How would the nurse determine the amount of chest tube drainage? 1 Aspirate the drainage from the collection chamber. 2 Clamp the chest tube and empty the fluid from the collection chamber. 3 Refer to the date and time markings on the outside of the collection chamber. 4 Replace the existing system with a new one to access the drainage in the existing system.

3 Refer to the date and time markings on the outside of the collection chamber.

The nurse is providing postoperative care to a client with cancer of the lung who had a lobectomy. The client has a chest tube attached to suction. Which assessment finding indicates a complication? 1 Clots in the tubing during the first postoperative day 2 Bloody fluid in the drainage-collection chamber on the first postoperative day 3 Subcutaneous emphysema on the second postoperative day 4 Decreased bubbling in the water-seal chamber on the third postoperative day

3 Subcutaneous emphysema on the second postoperative day

While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. Which action would the nurse take? 1 Place the client in the supine position. 2 Spread a clamp in the insertion site to hold the site open. 3 Obtain a sterile Vaseline gauze to cover the opening. 4 Cover the opening with the cleanest material available.

4 Cover the opening with the cleanest material available.

A client with a spontaneous pneumothorax asks, "Why did they put this tube into my chest?" Which information would the nurse provide about the purpose of the chest tube? 1 It checks for bleeding in the lung. 2 It monitors the function of the lung. 3 It drains fluid from the pleural space. 4 It removes air from the pleural space.

4 It removes air from the pleural space.

Which action would the nurse take to prevent complications when caring for a client with a chest tube to water seal drainage system for a pneumothorax? SATA 1 Emptying the drainage system when full 2 Keeping the drainage system at heart level 3 Notifying the health care provider of drainage greater than 50 mL/h 4 Marking the time on the drainage unit every shift 5 Laying the drainage system on its side during transport

4 Marking the time on the drainage unit every shift

A client has a chest tube in place for treatment of a pneumothorax. Upon entering the client's room, the nurse finds the client in respiratory difficulty, with the chest tube separated from the drainage system. Which action would the nurse take? 1 Notify the rapid response team. 2 Obtain a new sterile drainage system. 3 Use two clamps to close the drainage tube. 4 Reconnect the client's tube to the drainage system.

4 Reconnect the client's tube to the drainage system.

After thoracic surgery, a client has a chest tube connected to a water-seal drainage system that is attached to suction. When excessive bubbling is observed in the water-seal chamber, which action would the nurse take? 1 Strip the chest tube catheter. 2 Check the system for air leaks. 3 Decrease the amount of suction pressure. 4 Recognize that the system is functioning correctly.

2 Check the system for air leaks.

Which actions will the nurse include in the plan of care for a client with a left pneumothorax who has a chest tube in place? SATA 1 Immobilize the left arm in a sling. 2 Check the water-seal chamber for air bubbling. 3 Avoid use of nonsteroidal anti-inflammatory drugs. 4 Keep the client on bed rest in semi-Fowler position. 5 Observe frequently for drainage in the collection chamber. 6 Assist the client to cough and deep breathe every hour while awake.

2 Check the water-seal chamber for air bubbling. 6 Assist the client to cough and deep breathe every hour while awake.

A nurse is caring for a client with a pneumothorax who has a chest tube attached to a closed chest drainage system. If the chest tube and closed chest drainage system are effective, which type of pressure will be reestablished? 1 Neutral pressure in the pleural space 2 Negative pressure in the pleural space 3 Atmospheric pressure in the thoracic cavity 4 Intrapulmonic pressure in the thoracic cavity

2 Negative pressure in the pleural space