A nurse in the recovery room is assessing a client who has a new chest tube. The nurse finds that the water seal is no longer tidaling. The nurse should identify the finding as resulting from which of the following?

An air leak noted at the insertion site.

The tubing may be kinked.

Water needs to be added to the suction-control chamber.

The suction is set too low.

Answer and Explanation

The Correct Answer is B

A. An air leak noted at the insertion site: An air leak can cause continuous bubbling in the water seal chamber, but it does not prevent tidaling. Tidaling reflects intrathoracic pressure changes with respiration, so an air leak alone does not explain the absence of tidaling.

B. The tubing may be kinked: Tidaling stops when there is an obstruction in the chest tube system, such as a kinked or clamped tube. This prevents the normal movement of fluid in the water seal chamber that corresponds with the client’s respiratory cycle, making it the most likely cause of absent tidaling.

C. Water needs to be added to the suction-control chamber: Low water in the suction-control chamber affects the amount of suction delivered, not tidaling in the water seal chamber. The water seal chamber relies on the client’s respiration to show fluctuations, so adding water to suction does not restore tidaling.

D. The suction is set too low: Suction settings influence the rate of fluid evacuation and bubbling, but they do not control tidaling. Absence of tidaling usually indicates a mechanical obstruction rather than a suction problem.

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Correct Answer is A

Explanation

A. A brainstorming session with nurses: Brainstorming encourages open discussion and the generation of creative ideas to address a specific problem, such as rising rates of sexually transmitted infections. It allows the team to contribute multiple perspectives and potential interventions that can later be evaluated for feasibility and effectiveness.

B. A community-wide program: Implementing a program is an action step rather than a strategy for generating ideas. It is a solution that may be developed after identifying potential interventions through planning and brainstorming, rather than a method for idea generation itself.

C. Role playing with nurses: Role playing is a teaching and training strategy used to practice communication or counseling skills. While useful for preparing nurses to interact with clients, it does not generate new ideas for addressing a public health concern.

D. Personal discussions with clients: Talking with clients can provide valuable insight into individual behaviors and barriers, but it is not primarily a method for generating a broad range of innovative strategies. It serves more as a source of feedback or data rather than a creative ideation tool.

A. Hallucinations B. Аgnosia C. Bradycardia D. Aphasia

Correct Answer is A

Explanation

A. Hallucinations: Hallucinations are common in clients experiencing delirium, especially when it is related to a febrile or acute medical illness. They can involve seeing or hearing things that are not present and reflect the acute cognitive disturbances characteristic of delirium.

B. Agnosia: Agnosia is the inability to recognize familiar objects, people, or sounds and is more commonly associated with neurodegenerative disorders such as dementia rather than acute delirium. It is not a typical finding in febrile-induced delirium.

C. Bradycardia: Delirium related to a febrile illness usually does not cause bradycardia. Vital signs are more likely to show tachycardia due to fever or systemic infection. Bradycardia would suggest a different cardiac or medication-related issue.

D. Aphasia: Aphasia, the impairment of language expression or comprehension, is generally linked to stroke or localized brain injury. It is not a common manifestation of acute delirium caused by a febrile illness.

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A nurse in the recovery room is assessing a client who has a new chest tube. The nurse finds that the water seal is no longer tidaling. The nurse should identify the finding as resulting from which of the following?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse manager at a public health clinic is concerned about the rising number of sexually transmitted infections in the community. The purpose of which of the following is to generate new ideas to address the public health concern?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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