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NUR 198 EXAM PRACTICE QUESTIONS WITH
VERIFIED SOLUTIONS | 2026 UPDATE
What is a normal amount of suction for a chest tube? What type of liquid should you use?
- 20 sonimeters
- Sterile Water (NEVER NS) Where should the collection system be placed? Below the pt. or else the drainage could go back into the chest Is air normal in a water seal chamber for a pneumothorax? Yes, it will lessen as the pneumothorax is resolved What could happen if there is an air leak? What will the patient exhibit? Pt will not be able to take a deep breath HR will increase
- due to air/fluid build-up What should you do if there is an air leak and you can't find the the air leak in the system? Take the dressing off, and make sure the tube is still in the chest, and get a chest x-ray. If you take the dressing off and it is not in the right place you will feel subq emphysema. What is tidaling for a pt with a chest tube? Why does it occur? As pt takes a deep breath, the water in the seal chamber will rise, after they breathe out, it will go down. It is a reflection of the pressure in the pleural space. What should you do if a chest tube falls out?
Cover with sterile dressing and tape 3 sides Chest tube interventions
- drainage system upright and below chest level.
- incentive spirometry and deep breathing
- Never clamp the chest tube unless ordered (can cause tension pneumothorax).
- Monitor for subcutaneous emphysema (air under the skin – feels like “Rice Krispies”).
- Document drainage color, amount, and any changes.
- avoid lying on the affected side What should you know about DNRs? You cannot assume someone is DNR because they want to be. You have to have the legal, signed document in place.
- If there is a disagreement between family members, reach out to charge nurse, nurse supervisor, healthcare providers to figure it out What is a thoracentesis? surgical puncture to remove fluid from the pleural space Fluid causes you to not breathe well. Why would you do a thoracentesis over a chest tube?
- put pressure on insertion site post-procedure
- send fluid to lab What is the number one sign of pulmonary edema? Coughing up pink-tinged frothy sputum What are expected orders for pulmonary edema?
- diuretics (Furosemide/Lasix)
- morphine (decreases air hunger, anxiety, pre-load, and after-load of the heart)
- vasodilators (nitro, minoxidil) What position should you put a pt in that has pulmonary edema HOB up Pulmonary Edema manifestations/nursing care Dyspnea Tachypnea Cough Pink frothy sputum Cyanosis Crackles Tachycardia Hypoxemia
Orthopnea Lasix - diuretics Oxygen ↑ Positioning HOB ↑ monitor vitals (BP, respiratory), restrict fluids edu: ↓ sodium, daily weights, intubation/suction? Respiratory Alkalosis Ph level rises above 7.45 carbon dioxide falls below 35 Caused by hyperventilation, pneumonia, ARDS Symp: SOB, dizziness, chest pain, numbness in hands and feet Respiratory Acidosis Ph drops below 7.35 carbon dioxide level rises above 45 Cause by hypoventilation, pneumonia, COPD, asthma, benzos, opioids(overdose) SYMP: confusion, lethargy, dyspnea, palm cyanotic skin metabolic alkalosis
- support respiratory system with O2 (nasal cannula > non-rebreather > intubation/mechanical vent) COVID medical treatment Antivirals Antipyretics Anti-inflammatories MABs Anticoagulants Vaccination/booster Dysphagia nursing interventions
- Sit upright when eating
- thicken liquids
- no talking
- small frequent meals
- oral care
- suction available
- monitor swallowing
- monitor weight, I&O's COPD / ssx Chronic lung disease Emphysema + Bronchitis
ssx: chronic cough sputum production worse in the morning dyspnea weight loss "barrel chest" bronchospasm hyper-resonance COPD Meds
- bronchodilators
- anticholinergics
- corticosteroids
- antibiotics
- mucolytics
- antitussives COPD management ○ Tripod position ○ PFT's ○ Chest Xray ○ Pursed Lip breathing ○ Postural Drainage
- pinch soft portion of nose for 5- 10 minutes
- phenylephrine spray (vasoconstrict) cauterize with silver nitrate or electrocautery
- gauze packing or balloon inflated catheter inserted into nasal cavity for 3-4 days
- antibiotic therapy
- teach not to blow nose/humidify air laryngitis does no stretch
- hx of allergies (anaphylaxis)
- foreign body
- heavy alcohol/tabacco consumptions
- angio-edema
- angiotensin converting inhibitors
- recent throat pain/fever
- hx of surgery or previous tracheostomy SIGNS of obstruction-stridor/respiratory distress treat-epinephrine, Heimlich, emergency trach. laryngeal cancer
- Malignant cells occurring in the mucosal tissue of the larynx; more common in men between the ages of 55 and 70. laryngectomy surgical removal of the larynx nursing interventions for clients undergoing laryngectomy •Preoperative teaching •Reduce anxiety •Maintain patent airway, control secretions •Support alternative communication •Promote adequate nutrition and hydration •Promote positive body image, self-esteem •Monitor for potential complications Self-care management; homecare goals of tracheostomy management Improved gas exchange, adequate airway clearance, and prevention of infection. Nasal Cannula (NC) Nasal Cannula (NC) Flow Rate: 1 – 6 L/min FiO₂: 24%–44% Use: Low-flow oxygen for stable patients (e.g., mild hypoxemia, chronic lung disease).
FiO₂: 24%–60% Use: Precise oxygen delivery; ideal for COPD patients. face tent Flow Rate: Up to 10 L/min FiO₂: 28%–100% Use: For patients with facial trauma or burns; alternative to masks. Atelectasis •Closure or collapse of alveoli •Most common is acute atelectasis, which occurs postoperatively •Symptoms are insidious •Increasing dyspnea, cough, and sputum production •Tachycardia, tachypnea, pleural pain, and central cyanosis if large areas of the lung are affected •Characterized by increased work of breathing and hypoxemia •Decreased breath sounds and crackles over the affected area •Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear •Pulse oximetry may be < 90% Types of Pneumonia
•Inflammatory process triggered by infectious organisms or aspiration of an irritant •Edema and exudate in alveoli •Primary disease or complication of another disease/condition •Community acquired pneumonia (CAP) •Healthcare acquired pneumonia (HCAP) •Hospital acquired pneumonia (HAP) •Ventilator associated pneumonia (VAP) Pneumonia nursing management •High-Fowler position •Encourage deep breathing •Coughing/suctioning to remove secretions •Supplemental oxygen •Balance activity and rest periods •Adequate nutrition and fluids •Client education Pneumonia Medication managment •Pharmacotherapy •Antibiotics •Antipyretics •Bronchodilators •Anti-inflammatories Empyema
•Early detection and treatment Latent TB vs TB disease
- Latent:
- Child has the bacterium in their body but does not have TB disease and cannot spread the disease to others
- TB infection begins when bacilli are ingested by macrophages and presented to other white blood cells. This triggers an immune response in which white blood cells kill or encapsulate the bacilli. Granulomas then form and latent TB infection is established.
- TB Disease:
- If a pt is immunocompromised, tubercle bacilli overcome the immune system and TB disease develops TB Manifestations Cough, fever, chills, night sweats, fatigue, weight loss Dyspnea, chest pain & hemoptysis occurs as the disease progresses TB screening •PPD skin test •Screening tool •Tests only for exposure •Results read 48-72 hours after placement
- Does not determine active or latent disease
•Nucleic acid amplification testing •Detects presence of M. tuberculosis in respiratory secretions •Results in < 2 hr. •Most rapid and accurate screening test for TB •QuantiFERON-TB Gold and T-SPOT (serum) •Diagnostic for infection, whether active or latent •Acid-fast bacilli smear and culture (sputum) TB Pharmacotherapy •Treated for 6 to 12 months •Initiate treatment with multiple medications •Typical regimen includes isoniazid, rifampin, pyrazinamide, and ethambutol •Drug resistance is primary concern •Sputum samples needed every 2 to 4 weeks to monitor therapy effectiveness. •Clients no longer considered infectious after 3 consecutive negative sputum cultures •Complete all therapy ARF acute respiratory failure ARF Risk factors ARF clinical manifestations-Early signs •Early signs: restlessness, dyspnea, tachycardia, hypertension, fatigue, headache
•Maintain cuff pressure between 20- and 30- mm Hg •Intubation for no longer than 14 to 21 days (longer will require a tracheostomy) Mechanical ventilation: Nursing goals •Enhance gas exchange •Maintain patent airway •Avoid injury, infection, complications •Barotrauma and pneumothorax •Pulmonary infection and sepsis •Maintain adequate communication •Attain optimal mobility PANIC potential complications of Mechanical ventilation P-pressure injury A-Airway trauma N-Nutritional problems I-Infection C-Clots ARDS •ARDS is a clinical syndrome characterized by a severe inflammatory process causing diffuse alveolar damage that results in sudden and progressive pulmonary edema •Mortality rate of 25% to 45% •Rapid onset of severe dyspnea and ventilation/perfusion mismatch <72 hours after precipitating
event •Classified by severity of hypoxemia that does not respond to supplemental oxygen therapy Risk factors for ARDS •Sepsis •Shock •Disseminated intravascular coagulopathy (DIC) •Aspiration •Pulmonary emboli (fat, amniotic fluid) •Pneumonia and other pulmonary infections
- Near-drowning
- Trauma
- Multiple blood transfusions
- Damage to the CNS
- Smoke or toxic gas inhalation
- Opioid overdose
- Covid- 19 ARDS Clinical Manifestations •Dyspnea •Bilateral noncardiogenic pulmonary edema •Reduced lung compliance •Dense patchy bilateral pulmonary infiltrates on x-ray •Severe hypoxemia despite administration of 100% oxygen
