You are caring for a patient with a chest tube. You see that there is tidaling in the water-seal chamber as the patient breathes. You interpret this as what?
A kink at some location in the chest tube
Normal and is to be expected
The patient's lung has re-expanded and they are ready to have the chest tube removed
A problem within the chest tube unit
The Correct Answer is B
A. A kink at some location in the chest tube: A kink in the tubing would obstruct fluid or air flow and prevent tidaling. If tidaling is present, it indicates that the tube is patent, so a kink is unlikely.
B. Normal and is to be expected: Tidaling in the water-seal chamber represents the rise and fall of fluid with inspiration and expiration, reflecting normal changes in intrathoracic pressure. It is an expected finding and indicates that the chest tube system is functioning properly.
C. The patient's lung has re-expanded and they are ready to have the chest tube removed: Lung re-expansion is assessed via imaging and clinical signs, not solely by tidaling. Tidaling alone does not indicate readiness for removal.
D. A problem within the chest tube unit: Tidaling indicates that the chest tube unit is working correctly. A problem would be suspected if there were no fluid movement or continuous bubbling without patient respiratory activity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Increase PEEP: Positive end-expiratory pressure helps keep alveoli open at the end of expiration, improving oxygenation by increasing functional residual capacity and preventing alveolar collapse. Since the patient’s PaO2 is low (58 mmHg), increasing PEEP is the most effective first step to enhance oxygenation.
B. Increase respiratory rate: Increasing the respiratory rate primarily improves CO2 elimination rather than oxygenation. In this patient, hypoxemia is the priority concern, so adjusting rate will not adequately address low PaO2.
C. Increase FIO2: Increasing the fraction of inspired oxygen can raise PaO2, but prolonged high FIO2 levels increase the risk of oxygen toxicity. PEEP adjustments are generally prioritized before raising FIO2 to high levels.
D. Increase tidal volume: Raising tidal volume mainly improves CO2 removal and ventilation but has limited effect on oxygenation in a patient with alveolar collapse or shunting. Additionally, increasing VT carries a risk of volutrauma.
Correct Answer is A
Explanation
A. Potassium: Frequent use of albuterol, a beta-2 agonist, can cause a shift of potassium from the blood into the cells, leading to hypokalemia. Low potassium can result in muscle weakness, arrhythmias, and other cardiac complications, making it an important lab to monitor in this patient.
B. Sodium: Albuterol does not typically affect sodium levels. Monitoring sodium is not a primary concern in the context of frequent bronchodilator use unless there are other comorbidities affecting electrolyte balance.
C. White blood cells: WBC count is not directly affected by albuterol use. It is usually monitored for infection or inflammatory processes rather than medication side effects.
D. BUN and Creatinine: Renal function markers such as BUN and creatinine are not directly influenced by short-acting bronchodilator therapy. Monitoring these labs is not necessary solely due to albuterol administration.
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