NUR195 EXAM #2
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1. A nurse is caring for a client who has a chest tube b) apply sterile gauze to the in-
and drainage system in place. The nurse observes sertion site
that the chest tube was accidentally removed.
Which of the following actions should the nurse
take first?
a) obtain a chest x-ray
b) apply sterile gauze to the insertion site
c) place take around the insertion site
d) Assess respiratory status
2. A nurse is assessing a client who has a chest tube b) gentle constant bubbling in
and drainage system in place. Which of the follow- the suction control chamber
ing are expected findings? (SATA) c) rise and fall in the level of water
a) continuous bubbling in the water seal chamber in the water seal chamber with
b) gentle constant bubbling in the suction control inspiration and expiration
chamber
c) rise and fall in the level of water in the water seal
chamber with inspiration and expiration
d) exposed sutures without dressing
e) drainage system upright at chest level
3. A nurse is planning care for a client following the a) encourage the client to cough
insertion of a chest tube and drainage system. and deep breathe
Which of the following should be included in the b) check for continuous bubbling
plan of care? (SATA) in the suction chamber.
a) encourage the client to cough and deep e) obtain a chest x-ray
breathe.
b) check for continuous bubbling in the suction
chamber
c) strip the drainage tubing every 4 hours.
d) clamp the tube once a day
e) obtain a chest x-ray
1/5
, NUR195 EXAM #2
Study online at https://quizlet.com/_ddf982
4. A nurse is caring for a client who is receiving me- "It allows present pressure deliv-
chanical ventilation and is on pressure support ered during spontaneous venti-
ventilation mode. Which of the following state- lation".
ments by the nurse indicates an understanding of
PSV?
5. Which of the following early manifestations of hy- -Pale Skin
poxemia should the nurse recognize? -Hypertension
6. A nurse is reviewing the plan of care for a client -Synchronized intermittent
who is receiving mechanical ventilation. Which of mandatory ventilation
the following ventilator modes will increase the -Pressure Support Ventilation
client's work of breathing? (SATA) -Continuous positive airway
pressure
7. A nurse is monitoring a group of clients for in- A client with dysphagia,
creased risk for developing pneumonia. Which of A client who has AIDS
the following clients should the nurse expect to be A client who has a closed head in-
at risk? (SATA) jury and is receiving mechanical
ventilation
A client who has myasthenia
gravis
8. A nurse in the emergency department is caring for -Tachycardia
a client who is experiencing an acute asthma at- -Retraction of sternal muscles
tack. Which of the following assessments indicates -Wheezing
that the respiratory status is declining?
9. A nurse is caring for a client 2 hr after admission. -Beta2 Agonist (causes dilation of
The client has an SaO2 of 91% and exhibits audible the bronchioles to relieve wheez-
wheezes, and is using accessory muscles when ing)
2/5
Study online at https://quizlet.com/_ddf982
1. A nurse is caring for a client who has a chest tube b) apply sterile gauze to the in-
and drainage system in place. The nurse observes sertion site
that the chest tube was accidentally removed.
Which of the following actions should the nurse
take first?
a) obtain a chest x-ray
b) apply sterile gauze to the insertion site
c) place take around the insertion site
d) Assess respiratory status
2. A nurse is assessing a client who has a chest tube b) gentle constant bubbling in
and drainage system in place. Which of the follow- the suction control chamber
ing are expected findings? (SATA) c) rise and fall in the level of water
a) continuous bubbling in the water seal chamber in the water seal chamber with
b) gentle constant bubbling in the suction control inspiration and expiration
chamber
c) rise and fall in the level of water in the water seal
chamber with inspiration and expiration
d) exposed sutures without dressing
e) drainage system upright at chest level
3. A nurse is planning care for a client following the a) encourage the client to cough
insertion of a chest tube and drainage system. and deep breathe
Which of the following should be included in the b) check for continuous bubbling
plan of care? (SATA) in the suction chamber.
a) encourage the client to cough and deep e) obtain a chest x-ray
breathe.
b) check for continuous bubbling in the suction
chamber
c) strip the drainage tubing every 4 hours.
d) clamp the tube once a day
e) obtain a chest x-ray
1/5
, NUR195 EXAM #2
Study online at https://quizlet.com/_ddf982
4. A nurse is caring for a client who is receiving me- "It allows present pressure deliv-
chanical ventilation and is on pressure support ered during spontaneous venti-
ventilation mode. Which of the following state- lation".
ments by the nurse indicates an understanding of
PSV?
5. Which of the following early manifestations of hy- -Pale Skin
poxemia should the nurse recognize? -Hypertension
6. A nurse is reviewing the plan of care for a client -Synchronized intermittent
who is receiving mechanical ventilation. Which of mandatory ventilation
the following ventilator modes will increase the -Pressure Support Ventilation
client's work of breathing? (SATA) -Continuous positive airway
pressure
7. A nurse is monitoring a group of clients for in- A client with dysphagia,
creased risk for developing pneumonia. Which of A client who has AIDS
the following clients should the nurse expect to be A client who has a closed head in-
at risk? (SATA) jury and is receiving mechanical
ventilation
A client who has myasthenia
gravis
8. A nurse in the emergency department is caring for -Tachycardia
a client who is experiencing an acute asthma at- -Retraction of sternal muscles
tack. Which of the following assessments indicates -Wheezing
that the respiratory status is declining?
9. A nurse is caring for a client 2 hr after admission. -Beta2 Agonist (causes dilation of
The client has an SaO2 of 91% and exhibits audible the bronchioles to relieve wheez-
wheezes, and is using accessory muscles when ing)
2/5
