Test Bank for Clinical Manifestations and Assessment of Respirato
c c c c c c c c
ry Disease 8th Edition by Des Jardins
c c c c c c
Acpatientciscexhibitingcsignscofcacpneumothoraxcfollowingctracheostomy.cThecsurgeoncinser
tscacchestctubecintocthecanteriorcchestcwall.cWhatcshouldcthecnursectellcthecfamilyciscthecprim
arycpurposecofcthiscchestctube?
A) Tocremovecaircfromcthecpleuralcspace
B) Tocdrainccopiouscsputumcsecretions
C) Tocmonitorcbleedingcaroundctheclungs
D) Tocassistcwithcmechanicalcventilationc-cAns:cA
Feedback:
Chestctubescandcclosedcdrainagecsystemscarecusedctocre-
expandctheclungcinvolvedcandctocremovecexcesscair,cfluid,candcblood.cThecprimarycpurpose
cofcacchestctubeciscnotctocdraincsputumcsecretions,cmonitorcbleeding,corcassistcwithcmechan
icalcventilation.
Theccriticalccarecnurseciscpreceptingcacnewcnurseconcthecunit.cTogetherctheycareccaringcforc
acpatientcwhochascactracheostomyctubecandciscreceivingcmechanicalcventilation.cWhatcactio
ncshouldctheccriticalccarecnursecrecommendcwhenccaringcforctheccuff?
A) Deflatectheccuffcovernightctocpreventctrachealctissuectrauma.
B) Inflatectheccuffctocthechighestcpossiblecpressurecincorderctocpreventcaspiration.
C) Monitorcthecpressurecinctheccuffcatcleastceveryc8chours
D) Keepcthectracheostomyctubecpluggedcatcallctimes.c-cAns:cC
Feedback:
Cuffcpressurecmustcbecmonitoredcbycthecrespiratoryctherapistcorcnursecatcleastceveryc8chou
rscbycattachingcachandheldcpressurecgaugectocthecpilotcballooncofcthectubecorcbycusingcthec
minimalcleakcvolumecorcminimalcocclusioncvolumectechnique.cPluggingcisconlycusedcwhenc
weaningcthecpatientcfromctrachealcsupport.cDeflatingctheccuffcovernightcwouldcbecunsafecan
dcinappropriate.cHighccuffcpressureccanccausectissuectrauma.
Thecacutecmedicalcnurseciscpreparingctocweancacpatientcfromcthecventilator.cWhichcassessm
entcparameterciscmostcimportantcforcthecnursectocassess?
,A) Fluidcintakecforctheclastc24chours
B) Baselinecarterialcbloodcgasc(ABG)clevels
C) Priorcoutcomescofcweaning
D) Electrocardiogramc(ECG)cresultsc-cAns:cB
Feedback:
Beforecweaningcacpatientcfromcmechanicalcventilation,citciscmostcimportantctochavecbaselin
ecABGclevels.cDuringcthecweaningcprocess,cABGclevelscwillcbeccheckedctocassesschowcthec
patientcisctoleratingcthecprocedure.cOthercassessmentcparameterscarecrelevant,cbutclessccri
tical.cMeasuringcfluidcvolumecintakecandcoutputciscalwayscimportantcwhencacpatientciscbeing
cmechanicallycventilated.cPriorcattemptscatcweaningcandcECGcresultscarecdocumentedconct
hecpatient'screcord,candcthecnurseccancreferctocthemcbeforecthecweaningcprocesscbegins.
Thecnurseccaringcforcacpatientcwithcancendotrachealctubecrecognizescseveralcdisadvantage
scofcancendotrachealctube.cWhatcwouldcthecnursecrecognizecascacdisadvantagecofcendotrac
healctubes?
A) Cognitionciscdecreased.
B) Dailycarterialcbloodcgasesc(ABGs)carecnecessary.
C) Slightctrachealcbleedingciscanticipated.
D) Theccoughcreflexciscdepressed.c-cAns:cD
Feedback:
Therecarecseveralcdisadvantagescofcancendotrachealctube.cDisadvantagescincludecsuppre
ssioncofcthecpatient'sccoughcreflex,cthickeningcofcsecretions,candcdepressedcswallowingcrefl
exes.cUlcerationcandcstricturecofctheclarynxcorctracheacmaycdevelop,cbutcbleedingciscnotcanc
expectedcfinding.cThectubecshouldcnotcinfluenceccognitioncandcdailycABGscarecnotcalwayscr
equired.
Whatcwouldctheccriticalccarecnursecrecognizecascacconditioncthatcmaycindicatecacpatient'scn
eedctochavecactracheostomy?
A) Acpatientchascacrespiratorycratecofc10cbreathscpercminute.
B) Acpatientcrequirescpermanentcventilation.
,C) Acpatientcexhibitscsymptomscofcdyspnea.
D) Acpatientchascrespiratorycacidosis.c-cAns:cB
Feedback:
Actracheostomycpermitsclong-
termcusecofcmechanicalcventilationctocpreventcaspirationcofcoralcandcgastriccsecretionscincth
ecunconsciouscorcparalyzedcpatient.cIndicationscforcactracheostomycdocnotcincludecacrespir
atorycratecofc10cbreathscpercminute,csymptomscofcdyspnea,corcrespiratorycacidosis.
Thecmedicalcnursecisccreatingctheccarecplancofcancadultcpatientcrequiringcmechanicalcventila
tion.cWhatcnursingcactionciscmostcappropriate?
A) KeepcthecpatientcincaclowcFowler'scposition.
B) Performctracheostomyccarecatcleastconcecpercday.
C) Maintainccontinuouscbedrest.
D) Monitorccuffcpressureceveryc8chours.c-cAns:cD
Feedback:
Theccuffcpressurecshouldcbecmonitoredceveryc8chours.cItciscimportantctocperformctracheosto
myccarecatcleastceveryc8chourscbecausecofcthecriskcofcinfection.cThecpatientcshouldcbecencou
ragedctocambulate,cifcpossible,candcaclowcFowler'scpositionciscnotcindicated.
5. Thecnursecisccaringcforcacpatientcwhociscscheduledctochavecacthoracotomy.cWhencplann
ingcpreoperativecteaching,cwhatcinformationcshouldcthecnurseccommunicatectocthecpatient
?
A) Howctocmilkcthecchestctubing
B) Howctocsplintcthecincisioncwhenccoughing
C) Howctoctakecprophylacticcantibioticsccorrectly
D) Howctocmanagecthecneedcforcfluidcrestrictionc-cAns:cB
Feedback:
Priorctocthoracotomy,cthecnurseceducatescthecpatientcaboutchowctocsplintcthecincisioncwithcth
echands,cacpillow,corcacfoldedctowel.cThecpatientciscnotctaughtchowctocmilkcthecchest
, tubingcbecausecthisciscperformedcbycthecnurse.cProphylacticcantibioticscarecnotcnormallycu
sedcandcfluidcrestrictionciscnotcindicatedcfollowingcthoracotomy.
Acnursecisceducatingcacpatientcincanticipationcofcacprocedurecthatcwillcrequirecacwater-
csealedcchestcdrainagecsystem.cWhatcshouldcthecnursectellcthecpatientcandcthecfamilycthatcth
iscdrainagecsystemciscusedcfor?
A) Maintainingcpositivecchest-wallcpressure
B) Monitoringcpleuralcfluidcosmolarity
C) Providingcpositivecintrathoraciccpressure
D) Removingcexcesscaircandcfluidc-cAns:cD
Feedback:
Chestctubescandcclosedcdrainagecsystemscarecusedctocre-
expandctheclungcinvolvedcandctocremovecexcesscair,cfluid,candcblood.cTheycarecnotcusedctoc
maintaincpositivecchest-
wallcpressure,cmonitorcpleuralcfluid,corcprovidecpositivecintrathoraciccpressure.
Whilecassessingcthecpatient,cthecnursecobservescconstantcbubblingcincthecwater-
sealcchambercofcthecpatient'scclosedcchest-
drainagecsystem.cWhatcshouldcthecnursecconclude?
A) Thecsystemciscfunctioningcnormally.
B) Thecpatientchascacpneumothorax.
C) Thecsystemchascancaircleak.
D) Thecchestctubeciscobstructed.c-cAns:cC
Feedback:
Constantcbubblingcincthecchambercoftencindicatescancaircleakcandcrequirescimmediateca
ssessmentcandcintervention.cThecpatientcwithcacpneumothoraxcwillchavecintermittentcbu
bblingcincthecwater-
sealcchamber.cIfcthectubeciscobstructed,cthecnursecshouldcnoticecthatcthecfluidchascstopp
edcfluctuatingcincthecwater-sealcchamber.
Acpatientcrecoveringcfromcthoraciccsurgerycisconclong-
termcmechanicalcventilationcandcbecomescverycfrustratedcwhenchectriesctoccommunicat
e.cWhatcinterventioncshouldcthecnursecperformctocassistcthecpatient?
A) Assurecthecpatientcthatceverythingcwillcbecallcrightcandcthatcremainingccalmciscthecbestcst
rategy.
c c c c c c c c
ry Disease 8th Edition by Des Jardins
c c c c c c
Acpatientciscexhibitingcsignscofcacpneumothoraxcfollowingctracheostomy.cThecsurgeoncinser
tscacchestctubecintocthecanteriorcchestcwall.cWhatcshouldcthecnursectellcthecfamilyciscthecprim
arycpurposecofcthiscchestctube?
A) Tocremovecaircfromcthecpleuralcspace
B) Tocdrainccopiouscsputumcsecretions
C) Tocmonitorcbleedingcaroundctheclungs
D) Tocassistcwithcmechanicalcventilationc-cAns:cA
Feedback:
Chestctubescandcclosedcdrainagecsystemscarecusedctocre-
expandctheclungcinvolvedcandctocremovecexcesscair,cfluid,candcblood.cThecprimarycpurpose
cofcacchestctubeciscnotctocdraincsputumcsecretions,cmonitorcbleeding,corcassistcwithcmechan
icalcventilation.
Theccriticalccarecnurseciscpreceptingcacnewcnurseconcthecunit.cTogetherctheycareccaringcforc
acpatientcwhochascactracheostomyctubecandciscreceivingcmechanicalcventilation.cWhatcactio
ncshouldctheccriticalccarecnursecrecommendcwhenccaringcforctheccuff?
A) Deflatectheccuffcovernightctocpreventctrachealctissuectrauma.
B) Inflatectheccuffctocthechighestcpossiblecpressurecincorderctocpreventcaspiration.
C) Monitorcthecpressurecinctheccuffcatcleastceveryc8chours
D) Keepcthectracheostomyctubecpluggedcatcallctimes.c-cAns:cC
Feedback:
Cuffcpressurecmustcbecmonitoredcbycthecrespiratoryctherapistcorcnursecatcleastceveryc8chou
rscbycattachingcachandheldcpressurecgaugectocthecpilotcballooncofcthectubecorcbycusingcthec
minimalcleakcvolumecorcminimalcocclusioncvolumectechnique.cPluggingcisconlycusedcwhenc
weaningcthecpatientcfromctrachealcsupport.cDeflatingctheccuffcovernightcwouldcbecunsafecan
dcinappropriate.cHighccuffcpressureccanccausectissuectrauma.
Thecacutecmedicalcnurseciscpreparingctocweancacpatientcfromcthecventilator.cWhichcassessm
entcparameterciscmostcimportantcforcthecnursectocassess?
,A) Fluidcintakecforctheclastc24chours
B) Baselinecarterialcbloodcgasc(ABG)clevels
C) Priorcoutcomescofcweaning
D) Electrocardiogramc(ECG)cresultsc-cAns:cB
Feedback:
Beforecweaningcacpatientcfromcmechanicalcventilation,citciscmostcimportantctochavecbaselin
ecABGclevels.cDuringcthecweaningcprocess,cABGclevelscwillcbeccheckedctocassesschowcthec
patientcisctoleratingcthecprocedure.cOthercassessmentcparameterscarecrelevant,cbutclessccri
tical.cMeasuringcfluidcvolumecintakecandcoutputciscalwayscimportantcwhencacpatientciscbeing
cmechanicallycventilated.cPriorcattemptscatcweaningcandcECGcresultscarecdocumentedconct
hecpatient'screcord,candcthecnurseccancreferctocthemcbeforecthecweaningcprocesscbegins.
Thecnurseccaringcforcacpatientcwithcancendotrachealctubecrecognizescseveralcdisadvantage
scofcancendotrachealctube.cWhatcwouldcthecnursecrecognizecascacdisadvantagecofcendotrac
healctubes?
A) Cognitionciscdecreased.
B) Dailycarterialcbloodcgasesc(ABGs)carecnecessary.
C) Slightctrachealcbleedingciscanticipated.
D) Theccoughcreflexciscdepressed.c-cAns:cD
Feedback:
Therecarecseveralcdisadvantagescofcancendotrachealctube.cDisadvantagescincludecsuppre
ssioncofcthecpatient'sccoughcreflex,cthickeningcofcsecretions,candcdepressedcswallowingcrefl
exes.cUlcerationcandcstricturecofctheclarynxcorctracheacmaycdevelop,cbutcbleedingciscnotcanc
expectedcfinding.cThectubecshouldcnotcinfluenceccognitioncandcdailycABGscarecnotcalwayscr
equired.
Whatcwouldctheccriticalccarecnursecrecognizecascacconditioncthatcmaycindicatecacpatient'scn
eedctochavecactracheostomy?
A) Acpatientchascacrespiratorycratecofc10cbreathscpercminute.
B) Acpatientcrequirescpermanentcventilation.
,C) Acpatientcexhibitscsymptomscofcdyspnea.
D) Acpatientchascrespiratorycacidosis.c-cAns:cB
Feedback:
Actracheostomycpermitsclong-
termcusecofcmechanicalcventilationctocpreventcaspirationcofcoralcandcgastriccsecretionscincth
ecunconsciouscorcparalyzedcpatient.cIndicationscforcactracheostomycdocnotcincludecacrespir
atorycratecofc10cbreathscpercminute,csymptomscofcdyspnea,corcrespiratorycacidosis.
Thecmedicalcnursecisccreatingctheccarecplancofcancadultcpatientcrequiringcmechanicalcventila
tion.cWhatcnursingcactionciscmostcappropriate?
A) KeepcthecpatientcincaclowcFowler'scposition.
B) Performctracheostomyccarecatcleastconcecpercday.
C) Maintainccontinuouscbedrest.
D) Monitorccuffcpressureceveryc8chours.c-cAns:cD
Feedback:
Theccuffcpressurecshouldcbecmonitoredceveryc8chours.cItciscimportantctocperformctracheosto
myccarecatcleastceveryc8chourscbecausecofcthecriskcofcinfection.cThecpatientcshouldcbecencou
ragedctocambulate,cifcpossible,candcaclowcFowler'scpositionciscnotcindicated.
5. Thecnursecisccaringcforcacpatientcwhociscscheduledctochavecacthoracotomy.cWhencplann
ingcpreoperativecteaching,cwhatcinformationcshouldcthecnurseccommunicatectocthecpatient
?
A) Howctocmilkcthecchestctubing
B) Howctocsplintcthecincisioncwhenccoughing
C) Howctoctakecprophylacticcantibioticsccorrectly
D) Howctocmanagecthecneedcforcfluidcrestrictionc-cAns:cB
Feedback:
Priorctocthoracotomy,cthecnurseceducatescthecpatientcaboutchowctocsplintcthecincisioncwithcth
echands,cacpillow,corcacfoldedctowel.cThecpatientciscnotctaughtchowctocmilkcthecchest
, tubingcbecausecthisciscperformedcbycthecnurse.cProphylacticcantibioticscarecnotcnormallycu
sedcandcfluidcrestrictionciscnotcindicatedcfollowingcthoracotomy.
Acnursecisceducatingcacpatientcincanticipationcofcacprocedurecthatcwillcrequirecacwater-
csealedcchestcdrainagecsystem.cWhatcshouldcthecnursectellcthecpatientcandcthecfamilycthatcth
iscdrainagecsystemciscusedcfor?
A) Maintainingcpositivecchest-wallcpressure
B) Monitoringcpleuralcfluidcosmolarity
C) Providingcpositivecintrathoraciccpressure
D) Removingcexcesscaircandcfluidc-cAns:cD
Feedback:
Chestctubescandcclosedcdrainagecsystemscarecusedctocre-
expandctheclungcinvolvedcandctocremovecexcesscair,cfluid,candcblood.cTheycarecnotcusedctoc
maintaincpositivecchest-
wallcpressure,cmonitorcpleuralcfluid,corcprovidecpositivecintrathoraciccpressure.
Whilecassessingcthecpatient,cthecnursecobservescconstantcbubblingcincthecwater-
sealcchambercofcthecpatient'scclosedcchest-
drainagecsystem.cWhatcshouldcthecnursecconclude?
A) Thecsystemciscfunctioningcnormally.
B) Thecpatientchascacpneumothorax.
C) Thecsystemchascancaircleak.
D) Thecchestctubeciscobstructed.c-cAns:cC
Feedback:
Constantcbubblingcincthecchambercoftencindicatescancaircleakcandcrequirescimmediateca
ssessmentcandcintervention.cThecpatientcwithcacpneumothoraxcwillchavecintermittentcbu
bblingcincthecwater-
sealcchamber.cIfcthectubeciscobstructed,cthecnursecshouldcnoticecthatcthecfluidchascstopp
edcfluctuatingcincthecwater-sealcchamber.
Acpatientcrecoveringcfromcthoraciccsurgerycisconclong-
termcmechanicalcventilationcandcbecomescverycfrustratedcwhenchectriesctoccommunicat
e.cWhatcinterventioncshouldcthecnursecperformctocassistcthecpatient?
A) Assurecthecpatientcthatceverythingcwillcbecallcrightcandcthatcremainingccalmciscthecbestcst
rategy.
