The nurse prepares to assist the health care provider with the removal of a patient's chest tube.
Which priority instruction should the nurse provide to the patient immediately before removal?
Breathe in twice, then breathe out slowly with pursed lips.
Lie flat and breathe deeply so you won't feel pain.
Take a deep breath, hold it in, and bear down.
Inhale and exhale very rapidly until the tube is out.
The Correct Answer is C
Choice A rationale
Pursed-lip breathing is a technique used to slow down the breathing rate and facilitate a more complete exhalation, primarily beneficial for patients with obstructive lung diseases like COPD. It does not provide the positive intrathoracic pressure necessary to prevent air from entering the pleural space during a chest tube removal.
Choice B rationale
Lying flat and breathing deeply does not create the necessary positive pressure within the pleural cavity. This action would not prevent air from being sucked into the chest cavity, leading to a potential pneumothorax. The patient needs to increase intrathoracic pressure to seal the site.
Choice C rationale
The Valsalva maneuver, which involves taking a deep breath, holding it, and bearing down, increases intrathoracic pressure. This positive pressure helps to prevent air from rushing back into the pleural space when the chest tube is removed, thus minimizing the risk of a tension pneumothorax.
Choice D rationale
Rapid breathing, or hyperventilation, would decrease intrathoracic pressure and could potentially cause more air to be drawn into the pleural space upon removal of the chest tube. This action could lead to a tension pneumothorax. *.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Psoriasis is a chronic, autoimmune skin disorder characterized by the rapid overproduction of skin cells, leading to the formation of thick, red plaques covered with silvery-white scales. These lesions are a result of keratinocyte proliferation and inflammation. The most common sites for these plaques are the extensor surfaces of the body, such as the scalp, knees, and elbows, due to repetitive trauma or friction (Koebner phenomenon).
Choice B rationale
Red-purplish scaly lesions are more characteristic of other inflammatory skin conditions, such as lichen planus, not psoriasis. Psoriasis typically presents with a well-demarcated, erythematous base covered by silvery-white scales. The color and scale characteristics are key differentiators in the clinical diagnosis of skin disorders.
Choice C rationale
Psoriasis is typically associated with dry, not oily, skin. The rapid cell turnover and scale formation lead to significant epidermal dryness. Furthermore, pruritus (itching) is a common symptom of psoriasis, often a major source of discomfort for patients. The absence of pruritus is not a characteristic of this condition.
Choice D rationale
Nail changes are a very common manifestation of psoriasis, affecting up to 50% of patients. These changes include pitting, discoloration, onycholysis (separation of the nail from the nail bed), and thickening. Clear, thin nail beds are a sign of healthy nails, not a characteristic finding in a patient with psoriasis.
Correct Answer is A
Explanation
Choice A rationale
Beta-blockers, such as metoprolol, are generally contraindicated in patients with pulmonary hypertension. These medications can worsen the condition by further constricting pulmonary arteries and decreasing cardiac output. This negative effect is due to their blockade of beta-2 adrenergic receptors, which can lead to bronchospasm and pulmonary vasoconstriction.
Choice B rationale
Epoprostenol is a potent vasodilator and is a first-line treatment for severe pulmonary hypertension. It works by mimicking prostacyclin, a naturally occurring substance that relaxes smooth muscles in the pulmonary arteries, thereby reducing pulmonary artery pressure and improving blood flow.
Choice C rationale
Calcium channel blockers, like nifedipine, are used in a small subset of patients with pulmonary hypertension who are "vasoreactive.”. These drugs relax vascular smooth muscle, reducing pulmonary vascular resistance. They are a common therapeutic option for managing this condition in appropriate patients.
Choice D rationale
Warfarin, an anticoagulant, is often prescribed for patients with pulmonary hypertension to prevent the formation of blood clots (thrombi) in the small pulmonary arteries. These clots can further impede blood flow and worsen the disease, so anticoagulation is a standard part of the treatment regimen. *.
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