Post Test

1. A client has chest tubes due to a pneumothorax. The nurse recognizes that chest tubes may be used to: a. Regain positive intrapleural pressure b. Prevent pleural irritation c. Remove air and fluid from the intra-pleural space d. Establish negative pressure in the intra-alveolar space 2. Nursing care of the client with closed chest drainage should include : a. Clamping chest tube every 2 hours b. Elevating the chest tube higher then the clients chest c. Milking chest tube only if obstructed by clots d. Clamping chest tube when moving the patient 3. While bathing a client with chest tubes the nurse notices that there is continuous bubbling in the water seal chamber. This means that: a. There is a leak in the system b. The system is functioning properly c. The client is exhaling d. The client needs to be turned to the left 4. A physician asks you to assist him with the removal of his chest tube. You would instruct the client to: a. Continuously breathe normally during the removal of the chest tube b. Take a deep breathe , exhale and bear down c. Exhale upon actual removal of the chest tube d. Hold breath until the chest tube is pulled out 5. Chest tube diameter is measured or expressed in a. French

b. Millimeters c. Gauge d. Inches 6. When transporting a client with a chest tube, the system should be: a. Disconnected b. Closed c. Placed lower than the patients chest d. Placed between the legs of the client to prevent accidental breakage 7. In a client with new rib fractures which assessment finding would best alert the nurse to the possible development of a pneumothorax? a. Pink frothy sputum b. Hoarseness c. Decreased breath sounds on the affected side d. Dullness to percussion on the unaffected side 8. The nurse is caring for a client post thoracotomy after having been stabbed in the chest. He was attached to a 3 way water seal drainage system. Which is an appropriate nursing priority? a. Apply a thoracic binder to prevent tension in the chest wall b. Observe for fluid fluctuations in the water seal chamber c. Observe for fluid fluctuations in the suction control bottle d. Clamp tubing to prevent a rapid decline in pressure 9. A chest tube is inserted to decompress the lung. The most important purpose of this is to prevent which of the following complications? a. Hypoventilation b. Pain c. Pneumonia d. Mediastinal shifting

10.A client is admitted with severe dyspnea related to Pneumothorax. The nurse would expect to hear a. Bronchial breath sounds over affected area b. Hyperresonance on percussion of the affected lung c. Whispered pectoriloquy d. Increased tactile fremitus 11.The following statements are generally considered accurate for clients with pleural effusion EXCEPT. a. Associated diseases include PTB and Lung CA b. Chest Xray generally turns positive with fluids of more than 250 cc c. Primary management is through the use of antibiotics d. Signs and symptoms generally manifest with fluids greater than 100cc 12.A client is having a severe asthmatic attack. Which finding will reinforce your assessment? a. Bilateral crackles b. Wheezing c. Diminished breath sounds d. Stridor 13.A client with COPD complains of w 10 pound weight gain in a week. The complication that may have precipitated this weight gain is a. Polycythemia vera b. Cor pulmonale c. Left ventricular hypertrophy d. Compensated acidosis 14.A client with chronic bronchitis has unresolved bronchial infection in: a. 2 consecutive months in 3 consecutive years b. 3 consecutive months in 2 consecutive years c. 1 full year

d. 6 consecutive months within a year 15.A physician prescribes O2 at 2 LPM via nasal cannula for a patient with COPD. Which statement best describes why the patients O2 therapy is maintained at this relatively low level? a. Prolonged exposure to high O2 causes structural damage to the lung b. Increased o2 concentration of inspired air can cause alveoli to collapse c. Increased O2 can eliminate the stimulus for breathing in a patient with COPD d. O2 may affect the eyes causing tearing, edema and visual impairment 16.The physician orders aminophylline IV drip for the patient. The nurse should be alert for which sign of drug toxicity? a. Depression b. Tachycardia c. Lethargy d. Cyanosis 17.After the aminophylline drip is started the patients breathing improves. This occurs because aminophylline: a. Allows more air to enter the lungs b. Decreases respiratory rate and depth c. Helps the patient cough up thick secretions d. Increases respiratory rate and depth 18.The nurse understands that in the absence of pathology, a clients respiratory center is stimulated by: a. O2 b. Lactic acid c. Calcium d. CO2 19.A significant assessment finding in a client with a tension pneumothorax is: a. Tracheal deviation to the unaffected side b. Inspiratory stridor and respiratory distress

c. Diminished breath sounds over the affected side d. Hyper resonant percussion sound over the affected side 20.Which of the following is the emergency treatment for tension pneumothorax? a. Inserting a large bore needle into the intercostal space on the unaffected side b. Placement of a chest tube a chest tube through the mid sternum to reduce cardiac tamponade c. Attaching the chest tube to a continuous gravity drainage bag d. Inserting a large bore needle into the 2nd intercostal space on the affected side 21.Chest tube diameter is measured or expressed in a. French b. Gauge c. Millimeters d. Inches 22.When transporting a client with a chest tube the system should be: a. Disconnected b. Closed c. Placed lower than the patients chest d. Placed between the legs of the client to prevent breakage 23.The nurse enters the room of a client with COPD. The clients O2 is running at 6LPM, his color is pink and his respirations are 9/min. what is the best initial action? a. Take vital signs b. Call the physician c. Lower the O2 rate d. Put the client in Fowlers position 24.What is the primary purpose for instructing a client with COPD to use purse lip breathing? a. Prolonged exhalation helps prevent air trapping b. This trains the diaphragm to aid inspiration c. It improves the delivery of oral and nasal medications

d. It facilitates the movement of thick mucus 25.What is the purpose of the long glass tube that is immersed 3 cm below the water level in a water seal bottle? a. To humidify the air leaving the pleural space b. To allow the drainage to mix with sterile water c. To monitor the respirations by visualizing the fluctuation d. To prevent atmospheric air from entering the chest tube Situation: A 60 year old male client is admitted to the emergency department with crushing substernal chest pain that radiates to the shoulder, jaw, and left arm. The admitting diagnosis is acute MI. 26.Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead ECG, and 2 mg of morphine sulfate given intravenously. The nurse should first a. administer the morphine b. obtain a 12-lead ECG c. obtain the blood work d. order the chest radiograph 27.When administering a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of the drug is to a. help keep him well-hydrated b. dissolve clots that he may have c. prevent kidney failure d. treat potential cardiac dysrhythmias 28.If the client develops cardiogenic shock, which characteristic sign should the nurse expect to observe? a. oliguria b. bradycardia c. elevated blood pressure d. fever

29.The pain associated with MI is due to a. left ventricular overload b. impending circulatory collapse c. extracellular electrolyte imbalances d. insufficient oxygen reaching the heart muscle 30.Aspirin is administered to the client experiencing an MI because of its a. antipyretic action b. antithrombotic action c. antiplatelet action d. analgesic action 31.A basic principle of any rehabilitation program including cardiac rehabilitation, is that rehabilitation begins a. on discharge form the hospital b. on discharge form the cardiac care unit c. on admission to the hospital d. four weeks after the onset of illness 32.Alteplase recombinant, or tissue plasminogen activator (tPA), a thrombolytic enzyme, is administered during the first 3 hours after onset of MI to a. control chest pain b. reduce coronary artery vasospasm c. control the dysrhythmias associated with MI d. revascularize the blocked coronary artery 33.The client says to the nurse, my father died of a heart attack when he was 60, and I suppose I will too. Which of the following responses by the nurse would be the most appropriate? a. Tell me more about what you are feeling b. Are you thinking that you wont recover from this illness? c. You have a fine doctor. Everything will be all right soon, Im sure?

d. Would you agree that this would be very unlikely? 34.While caring for client who sustained an MI, the nurse notes eight premature ventricular contractions (PVCs) in one minute on the cardiac monitor. The client is receiving an intravenous infusion of 5% dextrose in water and 2 liters/minute of oxygen. The nurses first course of action should be to a. increase the intravenous infusion rate b. notify the physician promptly c. increase the oxygen concentration d. administer a prescribed analgesic 35.Crackles heard on lung auscultation indicate a. pulmonary edema b. bronchospasm c. airway narrowing d. fluid-filled alveoli

36.Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema? a. high risk for infection related to stasis of secretions in alveoli b. impaired skin integrity related to pressure c. activity intolerance related to imbalance between oxygen supply and demand d. constipation related to immobility 37.The major goal of therapy for this client would be to a. increase cardiac output b. improve respiratory status c. decrease peripheral edema d. enhance comfort 38.Digoxin is administered intravenously to this client, primarily because the drug acts to

a. dilate coronary arteries b. increase myocardial contractility c. decrease cardiac dysrhythmias d. decrease electrical conductivity in the 39.The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help a. decrease GI irritation b. retard rapid drug absorption c. excrete fluids accumulated during the night d. prevent sleep disturbances during the night 40.The nurse should teach the client that signs of digitalis toxicity include a. skin rash over the chest and back b. increased appetite c. colored vision d. elevated BP 41.The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a a. low sodium level b. high glucose level c. high calcium level d. low potassium level 42.Long term complications of HPN include a. renal insufficiency and failure b. valvular heart diasease c. endocariditis d. peptic ulcer disease

43.The nurse teaches a client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to a. open and dilate blocked coronary arteries b. assess the extent of arterial blockage c. bypass obstructed vessels d. assess the functional adequacy of the valves and heart muscle 44.The nurses teaches the client with angina about the common expected side effects of nitroglycerin, including a. headache b. high blood pressure c. shortness of breath d. stomach cramps 45.Proper hand placement for chest compressions during cardiopulmonary resuscitation (CPR) is essential to prevent what complication? a. GI bleeding b. MI c. Emesis d. Rib fracture 46.The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. Outcome criteria include that the client a. Selects a low-cholesterol diet to control CAD b. States a need for bed rest for one week after discharge c. Verbalizes safety precautions needed to prevent pacemaker malfunction d. Explains signs and symptoms of myocardial infarction 47. Which is not an appropriate health teaching to a patient prescribed with nitroglycerine (NTG): a. Replace NTG every 6 months

b. Always carry one or 2 tablets of NTG in your pocket for emergency need c. Take only up to 3 tablets of NTG d. Do not expose NTG to sun or extreme heat 48.Which of the following drugs is not used for the treatment of cardiac arrest? a. Dopamine hydrochloride b. Norepinephrine c. Sodium bicarbonate d. Nitroglycerin 49.A client with a prescription of sodium warfarin (Coumadin) should be given the following instructions, except: a. Check for bleeding b. Eat green leafy vegetables once a week c. Inject the drug subcutaneously only d. Avoid engaging in contract sports or using power tools 50. Before administering digoxin (Lanoxin) to a cardiac patient, the most important responsibility of the nurse to the patient is to: a. Assess the apical pulse b. Measure the blood pressure c. Verify the doctors order d. Count the respiratory rate