31. A client is diagnosed with a spontaneous pneumothorax necessitating
the insertion of
a chest tube. What is the best explanation for the nurse to provide this
client?
A) "The tube will drain fluid from your chest.
...
31. A client is diagnosed with a spontaneous pneumothorax necessitating
the insertion of
a chest tube. What is the best explanation for the nurse to provide this
client?
A) "The tube will drain fluid from your chest."
B) "The tube will remove excess air from your chest."
C) "The tube controls the amount of air that enters your chest."
D) "The tube will seal the hole in your lung."
The correct answer is B: "The tube will remove excess air from your
chest."
32. The nurse is reviewing laboratory results on a client with acute renal
failure. Which
one of the following should be reported immediately?
A) Blood urea nitrogen 50 mg/dl
B) Hemoglobin of 10.3 mg/dl
C) Venous blood pH 7.30
D) Serum potassium 6 mEq/L
The correct answer is D: Serum potassium 6 mEq/L
33. The nurse is caring for a client undergoing the placement of a central
venous catheter
line. Which of the following would require the nurse’s immediate
attention?
A) Pallor
B) Increased temperature
C) Dyspnea
D) Involuntary muscle spasms
The correct answer is C: Dyspnea
34. The nurse is performing a physical assessment on a client who just
had an
endotracheal tube inserted. Which finding would call for immediate action
by the nurse?
A) Breath sounds can be heard bilaterally
B) Mist is visible in the T-Piece
C) Pulse oximetry of 88
D) Client is unable to speakThe correct answer is C: Pulse oximetry of 88
35. A nurse checks a client who is on a volume-cycled ventilator. Which
finding indicates
that the client may need suctioning?
A) drowsiness
B) complaint of nausea
C) pulse rate of 92
D) restlessness
The correct answer is D: restlessness
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