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1. A patient is hospitalized with symptoms of tuberculosis (TB). The nurse recognizes that at least one of the sputum specimens for acid- fast bacilli (AFB) needs to be obtained at which time of the day? a. 6am i. Culture is the gold standard for diagnosing TB. Three consecutive sputum specimens are needed, each collected at 8- to 24-hour intervals, with at least one early-morning specimen. The initial test involves a microscopic examination of stained sputum smears for AFB. Early morning (6 a.m.) is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. The times of 12 noon, 6 p.m., and 9 p.m. are not ideal times to collect the specimen because the amount of secretions for the specimen may not be optimal.
2. Which type of chest surgery is indicated for a patient with chest trauma? a. Exploratory thoracotomy i. An is an incision into the thorax to look for injured or bleeding tissues. It is indicated for a patient with chest trauma. Pneumonectomy is indicated for a patient with lung cancer. Segmental resection is indicated for a patient with bronchiectasis. Lung volume reduction surgery is indicated

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for a patient with advanced bullous emphysema.

3. A patient presents to the emergency room with severe dyspnea, tachycardia, tracheal deviation, and neck vein distention. Which condition does the nurse suspect? a. Tension pneumothorax i. Tension pneumothorax is the result of increased air in the pleural space; it causes shifting of bodily organs and an increase in intrathoracic pressure. Manifestations of a tension pneumothorax include severe dyspnea, marked tachycardia, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, cyanosis, and profuse diaphoresis. 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.

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4. When a patient is diagnosed with a lung abscess, which does the nurse teach the patient? a. Oral antibiotics will be used when the patient and x-ray show evidence of improvement. i. IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic, as well as at the completion of the antibiotic therapy.
5. The nurse provides care for a patient who experienced chest trauma. When the nurse assesses the right lung, which finding suggests a right-sided pneumothorax? a. Absence of breath sounds i. A pneumothorax indicates that one of the lungs has collapsed and is not functioning. Manifestations of a pneumothorax include dyspnea, decreased movement of the involved chest wall, decreased or absent breath sounds

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on the affected side, and hyperresonance on percussion. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Assessment findings will include hyperresonance on percussion.

6. The nurse reviews a patient’s medical record and notes the presence of ruptured small blebs on the surface of the lung. The nurse identifies that the finding is consistent with which type of pneumothorax? a. Spontaneous i. A spontaneous pneumothorax typically occurs as a result of the rupture of small blebs (air-filled sacs) on the surface of the lung. These blebs can occur in healthy young people or from lung

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disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. A tension pneumothorax is a complication associated with the presence of excessive air in the pleural thorax that cannot escape. This condition results in increased intracranial pressure. A traumatic pneumothorax is a type of chest trauma associated with an opening in the pleural space that results in air entering the pleural space. An iatrogenic pneumothorax is a type of chest trauma that occurs as a result of laceration or puncture of the lung.

7. The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum, and a respiratory rate of 20 breaths/minute. Which is an appropriate nursing diagnosis? a. Hyperthermia related to infectious illness i. cause the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and the patient's breathing pattern is within normal limits at 20 breaths/minute. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating

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sputum.

8. A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Which instructions does the nurse provide for the patient? Select all that apply. a. Get adequate rest b. Restrict fluid intake c. Avoid alcohol and smoking d. Resume work to build strength e. Take every dose of the prescribed antibiotic i. oT ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period.

9. The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? a. No treatment may be needed i. Treatment of a pneumothorax depends on its severity, its

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underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications. Aspiration with a large- bore needle is thoracentesis. This procedure is performed when the patient has fluid accumulation in the complete lung. Needle decompression helps to resolve pneumothorax when the patient has a medical emergency.

10. The nurse provides education for a group of nursing students about acute bronchitis and includes which information? a. Treatment is mainly supportive i. Acute bronchitis is usually self-limiting, and the treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis from pneumonia. With bronchitis, no consolidation or infiltrates will be seen on an x-ray as there is with pneumonia. If patients with acute bronchitis develop a fever, have difficulty breathing, or have symptoms last longer than four weeks, they should see their HCP. Because there is no consolidation, egophony would not

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be auscultated. Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is caused by the enhanced transmission of high- frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out.

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11. The health care provider prescribes IV vancomycin for a patient with pneumonia. Which action does the nurse perform first? a. Obtain sputum cultures for sensitivity i. The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs, education, and white blood cell count measurement can be assessed following the obtainment of sputum cultures.
12. Which type of procedure allows the health care provider to manipulate instruments passed into the pleural space? a. Video-assisted thoracoscopic surgery i. 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.
13. A patient with a sudden onset of respiratory distress is scheduled

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for a ventilation-perfusion scan. Which instruction does the nurse provide to the patient about the procedure? a. The test involves the injection of a radioisotope and the inhalation of a radioactive gas i. A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood, and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal.

14. A pediatric patient presents with a 2-week history of cough, clear sputum, headache, hoarseness, and myalgias. The patient has no significant medical history. The patient's parent asks why there is no plan to administer an antibiotic. How does the nurse respond? a. Explain that antibiotics are not required for the patient i. The symptoms and signs indicate that the patient may have acute bronchitis, which is a viral disorder. Therefore the nurse should explain to the parent that antibiotics will not help in viral infections. If they are prescribed, antibiotics may cause side effects and may also lead to antibiotic

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resistance. It is incorrect to advise the parent to see another health care provider, who will likely prescribe a similar course of treatment. The symptoms are not indicative of pertussis. Bronchodilators are not used to treat pertussis. Acute bronchitis is a self-limiting disorder, and the cough may last up to 3 weeks. Informing the parent that antibiotics will be prescribed if the cough persists for another week is not correct.

15. A patient experiences a sucking chest wound as a result of a surgical thoracotomy. Which type of pneumothorax does the nurse suspect? a. Traumatic i. 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. A surgical thoracotomy can cause sucking chest wounds and result in a traumatic pneumothorax. A tension pneumothorax is the condition associated with the accumulation of air in the pleural space, resulting in lung compression. An iatrogenic pneumothorax is the result of trauma to the chest wall that occurs during a medical procedure such as thoracentesis. A spontaneous pneumothorax is chest wall trauma that is

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associated with the rupture of small blebs.

16. A patient with no significant health history presents to the emergency department reporting a sudden onset of shortness of breath. The nurse auscultates the lungs and notes that there are no breath sounds in the right upper lobe. The nurse suspects which type of pneumothorax? a. Spontaneous i. A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs as a result of the rupture of small blebs (air-filled sacs) on the surface of the lung. These blebs can occur in healthy young people or from lung disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. A 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. An iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. A traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma.

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17. A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient’s history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? a. Aspiration pneumonia i. Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. The aspirated material (food, water, vomitus, oropharyngeal secretions) triggers an inflammatory response. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression; therefore opportunistic pneumonia did not occur in this patient.

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18. How does splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? a. It facilitates deep breathing i. The patient will have difficulty breathing after surgery as a result of the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range-of-motion exercise to increase perfusion or oxygen supply to the injured site.
19. Which surgical lung procedure involves the removal of a small, localized lesion that occupies only part of a segment? a. Wedge resection i. A wedge resection is the removal of a small, localized lesion that occupies only part of a segment. Pleurodesis is the surgical procedure that helps in the adhesion of the visceral and parietal pleura in the patient who has a pneumothorax. Pleural biopsy is a procedure in which a sample of pleural cells is examined for tumors. Thoracentesis is a procedure that is performed to drain the fluid from the pleural space.
20. The nurse determines that additional discharge teaching is needed

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for a patient with pneumonia when the patient makes which statement? a. I should take antibiotics for all upper respiratory infections i. Antibiotics are not indicated for all upper respiratory tract infections, such as viral infections, because they have side effects and promote antibiotic resistance. It is important for the patient to continue with coughing and deep breathing exercises for at least six weeks, until all of the infection has cleared from the lungs. The patient should take all medications as prescribed and seek medical attention for signs or symptoms of a new infection.

21. Which 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? a. To expose the midaxillary area i. The midaxillary area is the standard site for the 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 top of the rib to avoid the intercostal nerves.

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22. When caring for a patient with pertussis, which intervention does the nurse prioritize? a. Administering antibiotic therapy i. The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. For the patient who cannot take macrolides, trimethoprim/sulfamethoxazole is used. Cough suppressants and antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms.
23. The nurse provides which information about the water-seal chamber on a chest drainage unit (CDU) when educating a group of nursing students? a. It contains 2 cm of water i. 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.
24. The nurse provides teaching for a patient who is scheduled for a

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bedside thoracentesis. Which does the nurse explain as the primary purpose of the procedure? a. Relieving an abnormal accumulation of fluid in the pleural space i. Thoracentesis involves the insertion of a large-bore needle into the pleural space to relieve an abnormal accumulation of fluid in the pleural space. The procedure can significantly relieve symptoms related to this fluid accumulation, such as shortness of breath and discomfort. Thoracentesis cannot reveal the stage of lung cancer or permit direct inspection and examination of the pleural space. It may provide a pleural fluid specimen but not a pleural tissue specimen.

25. The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? a. I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution i. The follow-up chest x-ray will be done in six to eight weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than seven days. It may be important for the patient to continue with deep-breathing exercises for six to eight weeks, not 12 weeks, until all of the infection has cleared from the lungs. Increased fluid intake, not caloric

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intake, is recommended to liquefy secretions.

26. Which condition in a patient with chest trauma requires treatment with positive pressure ventilation? a. Flail chest i. Flail chest results in a loss of chest stability as a result of fracture of the ribs. The nurse should stabilize the flail segment with positive pressure ventilation (intubation and mechanical ventilation as needed). The nurse performs needle decompression to treat cardiac tamponade. The patient with a hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage, and positive pressure ventilation aggravates the patient’s condition.
27. A patient has a chest tube inserted to treat a pneumothorax. Which observation causes the nurse to conclude that the water- seal chamber of the chest drainage unit (CDU) is functioning properly? a. The level in the water-seal chamber fluctuates with respirations i. The water-seal chamber level fluctuates with respirations as a result of the restoration of negative pressure within the thoracic cavity. If there is no bubbling in the suction control chamber, (1) there is no suction, (2) the suction is not high

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enough, or (3) the pleural air leak is so large that the suction is not high enough to evacuate it. The wall suction regulator should be set until there is continuous gentle bubbling in the suction control chamber (generally 80 to 120 mm Hg). The water-seal chamber should not contain blood; this finding indicates that the chest tube drainage system may have overturned and should be replaced.

28. The nurse is providing postoperative care for a patient three days after a total knee arthroplasty. The patient reports a sudden onset of shortness of breath, slight chest pain, and that "something is wrong." The assessment findings include a temperature of 98.4°F (36.9°C), BP 130/88 mm Hg, respirations 36 breaths/min, and an oxygen saturation reading of 91% on room air. Which immediate action does the nurse take?

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a. Sit the patient up in bed as tolerated and apply oxygen i. The patient's clinical picture is most likely pulmonary embolism (PE), and the first action the nurse should take is to assist with the patient's respirations. The prognosis of a patient with PE is good if therapy is started immediately. The nurse should keep the patient on bed rest in a semi- Fowler’s position to facilitate breathing. The nurse should assess the patient’s cardiopulmonary status with careful monitoring of vital signs, cardiac rhythm, pulse oximetry, arterial blood gases (ABGs), and lung sounds. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before eliciting additional help. A Code Blue would not be called unless the patient experiences a loss of pulse and/or respirations. The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time.

29. A patient with chest trauma has a chest tube in place. Upon entering the patient’s room, the nurse notes that the chest tube is completely broken at the midpoint and is no longer attached to the drainage unit. Which action does the nurse take? a. Places the tubing in a sterile water container i. The drainage system should be properly checked to lessen

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the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced.

30. Forty-eight hours after a patient received an intradermal tuberculin skin test (Mantoux), the nurse assesses the injection site and notes a 12-mm area of palpable induration. How does the nurse interpret this result? a. A significant indication that the patient has been exposed to tuberculosis i. The test is read by inspection and palpation 48 to 72 hours later for the presence or absence of induration. Induration, a palpable, raised, hardened area or swelling (not redness) at the injection site, means the person has been exposed to tuberculosis and has developed antibodies. The other answer options are incorrect conclusions related to the findings.3
31. The registered nurse is evaluating the actions of a nursing student

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who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. a. Coils the tubing above the chest level b. Expects air fluctuations in the water-seal chamber c. Verifies the presence of an air-occlusive dressing over the insertion site d. Connects the chest tube to wall suction to check for tidaling e. Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber i. Coiling of the tubing above the chest level may cause fluid to drain back into the pleural cavity. Therefore the tubing of the drainage system should be coiled below the chest level. The chest tube should be disconnected from wall suction to check the tidaling because the suction will be increased. An absence of air fluctuations in the water-seal chamber indicates blockage of the tubing. The dressing of the drainage system should be air-occlusive to prevent leakage. The tubing should be dropped straight from the bed or chair to the drainage unit for easy flow.

32. A patient experiences a chest injury as a result of a motor

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vehicle accident. The patient’s assessment findings include asymmetric chest excursion and an absence of breath sounds on the left side. Which condition does the nurse suspect? a. Left-sided pneumothorax i. A pneumothorax should be suspected after any trauma to the chest wall. A pneumothorax is caused by air entering the pleural cavity. The pleural space has a few milliliters of lubricating fluid to reduce friction when the tissues move. When air enters this space, the change in positive pressure causes a partial or complete lung collapse. As the volume of air in the pleural space increases, lung volume decreases. The patient described experienced a closed (no external wound) pneumothorax. When the left part of a chest is crushed, breathing will be compromised, resulting in asymmetric excursion. On auscultation, breath sounds are absent over the affected area. PE is an abnormal collection of fluid in the pleural space. Clinical manifestations associated with PE include dyspnea, hypoxemia, tachypnea, cough, chest pain, hemoptysis, crackles,

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wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. There is not enough information to conclude that ARDS has developed. The risk for ARDS is greater after the initial injury, not at the time of the injury.

33. A patient with a diagnosis of chylothorax is prescribed octreotide. Which outcome does the nurse expect after the treatment a. Reduced flow of lymphatic fluid i. Chylothorax is a type of chest injury that is associated with the 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 the pleural space. The patient with chylothorax will not need hydration and IV fluids. The nurse administers analgesia for adequate pain control. Octreotide does not reduce the risk of hypoxemia. 34. Which instructions does the nurse provide to a patient with acute bronchitis? Select all that apply. a. Increase oral fluid intake b. Avoid secondhand smoke

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c. Maintain a 30-degree head elevation when in bed d. Avoid throat lozenges because they may induce coughing e. Eat a spoonful of honey to help relieve cough i. The goal of treatment is to relieve symptoms and prevent pneumonia. Treatment is supportive. It includes encouraging oral fluid intake. Honey may help relieve cough. The nurse should encourage patients not to smoke, to avoid secondhand smoke, and to wash their hands often. The patient should be positioned in an upright sitting position (high Fowler's) with the head slightly flexed. Throat lozenges may help relieve cough.

35. Following a thoracotomy, a patient uses patient-controlled analgesia (PCA). Which related outcomes does the nurse expect? Select all that apply. a. The patient will have an effective cough b. The patient will be able to take deep breaths. c. The patient will have reexpansion of the lungs d. The patient will have reduced pulmonary edema e. The patient will be able to move the arm on the operative side i. Thoracotomy is a painful procedure and involves cutting

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