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Chest tubes

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Question 1:

A nurse is caring for a client with diabetes who presents with elevated blood sugar levels and excessive thirst. The nurse understands that these symptoms are primarily caused by:

A. Increased insulin production. B. Decreased glucose production by the liver. C. Inadequate cellular uptake of glucose. D. Overproduction of glucagon by the pancreas.

Answer and Explanation

Choice A:

Increased insulin production is not the primary cause of elevated blood sugar levels and excessive thirst in a client with diabetes. In fact, in type 1 diabetes, there is a lack of insulin production, while in type 2 diabetes, there is insulin resistance, both leading to inadequate cellular uptake of glucose.

Choice B:

Decreased glucose production by the liver is also not the primary cause of the symptoms. In diabetes, the liver can overproduce glucose, especially in the fasting state, contributing to hyperglycemia.

Choice C:

Inadequate cellular uptake of glucose is the correct choice. In diabetes, the body's cells do not effectively utilize glucose due to either insufficient insulin or insulin resistance, leading to high blood sugar levels in the blood.

Choice D:

Overproduction of glucagon by the pancreas is not the primary cause of elevated blood sugar levels and excessive thirst. Glucagon, a hormone produced by the pancreas, raises blood sugar levels when necessary, but it is not the main culprit in diabetes.

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Question 2:

A client diagnosed with diabetes asks the nurse about dietary recommendations. The nurse should advise the client to limit the intake of which of the following foods? Select all that apply:

A. Whole grains. B. Fruits. C. Green leafy vegetables. D. Saturated fats. E. Lean protein.

Answer and Explanation

Choice A:

Whole grains are generally recommended for individuals with diabetes as they provide a steady source of energy and contain fiber, which can help manage blood sugar levels.

Choice B:

Fruits should be limited because they contain natural sugars, which can raise blood sugar levels. While fruits are a healthy choice, it's essential for people with diabetes to monitor their intake and choose lower-sugar options.

Choice C:

Green leafy vegetables are generally encouraged for individuals with diabetes as they are low in calories and carbohydrates and have a positive impact on blood sugar levels.

Choice D:

Saturated fats should be limited because they can contribute to insulin resistance and increase the risk of heart disease, which is already elevated in people with diabetes.

Choice E:

Lean protein is a good choice for individuals with diabetes as it can help stabilize blood sugar levels and promote satiety without contributing to significant fluctuations in glucose.

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Question 3:

A nurse is providing education to a client with diabetes on foot care. The nurse should include which statement to promote foot health?

A. "You should walk barefoot at home to improve circulation.". B. "Inspect your feet daily, especially between the toes.". C. "Apply heating pads to your feet for warmth in cold weather.". D. "Use adhesive tape to treat any blisters or sores on your feet.".

Answer and Explanation

Choice A:

Walking barefoot at home is not advisable for a client with diabetes. It can increase the risk of injury and foot complications, as individuals with diabetes may have reduced sensation in their feet, making it difficult to detect injuries promptly.

Choice B:

"Inspect your feet daily, especially between the toes.”. This is the correct choice. Daily foot inspection is crucial for early detection of any signs of injury, infection, or changes in the skin. Early intervention can prevent more severe foot complications in individuals with diabetes.

Choice C:

Applying heating pads to the feet for warmth in cold weather is not recommended for individuals with diabetes, as they may have reduced sensitivity to temperature changes and can accidentally burn their feet.

Choice D:

Using adhesive tape to treat blisters or sores on the feet is not advised. Any wounds or foot issues should be assessed and treated by a healthcare professional to prevent infection and promote proper healing.

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Question 4:

A client with diabetes reports feeling shaky, weak, and dizzy. The nurse suspects hypoglycemia. Which statement by the client supports this suspicion?

A. "I haven't been eating much lately.". B. "I've been drinking a lot of water recently.". C. "I feel tired and lethargic all the time.". D. "My heart has been racing throughout the day.".

Answer and Explanation

Choice A:

The client's statement, "I haven't been eating much lately,”. supports the suspicion of hypoglycemia. When a person with diabetes does not eat enough, especially if they are taking insulin or certain oral medications, their blood sugar levels can drop, leading to hypoglycemia. The symptoms reported by the client, including feeling shaky, weak, and dizzy, are typical manifestations of low blood sugar.

Choice B:

"I've been drinking a lot of water recently”. does not support the suspicion of hypoglycemia. This statement could indicate hyperglycemia instead, as excessive thirst (polydipsia) is a common symptom of high blood sugar in diabetes.

Choice C:

"I feel tired and lethargic all the time”. is a non-specific symptom and does not directly indicate hypoglycemia. Fatigue can be caused by various factors, and in this case, there is no clear link to low blood sugar.

Choice D:

"My heart has been racing throughout the day”. is also not indicative of hypoglycemia. Rapid heart rate (tachycardia) can have multiple underlying causes, and it is not a primary symptom of low blood sugar.

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Question 5:

A nurse is preparing to administer insulin to a client with diabetes. Before administering the insulin, the nurse should prioritize which action?

A. Assessing the client's blood pressure. B. Monitoring the client's blood glucose levels. C. Asking the client about any allergies. D. Checking the client's oxygen saturation.

Answer and Explanation

Choice A:

Assessing the client's blood pressure is important but not the priority before administering insulin. High or low blood pressure can be a concern in clients with diabetes, but checking blood glucose levels takes precedence when preparing to administer insulin.

Choice B:

The nurse should prioritize monitoring the client's blood glucose levels before administering insulin. It is essential to know the client's current blood sugar level to determine the appropriate dose of insulin to administer safely. Giving insulin without knowing the current blood glucose level can lead to hypoglycemia or hyperglycemia, both of which can be dangerous for the client.

Choice C:

Asking the client about any allergies is a good practice before administering any medication, but it is not the priority in this situation. The immediate concern is to address the hyperglycemia with insulin while ensuring the client's safety.

Choice D:

Checking the client's oxygen saturation is not directly related to insulin administration for diabetes. It may be relevant in certain medical conditions or emergencies, but it is not a priority action before giving insulin.

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Question 6:

A client with diabetes is admitted to the hospital with hyperglycemia. The healthcare provider prescribes regular insulin IV. The nurse should administer the insulin using which technique?

A. Intramuscular injection. B. Subcutaneous injection. C. Intradermal injection. D. Intravenous bolus injection. E. Intravenous infusion pump.

Answer and Explanation

Choice A:

Intramuscular injection is not the recommended route for insulin administration in this situation. It is a slower route, and the absorption may not be predictable, which could delay the desired effect of lowering blood glucose levels.

Choice B:

Subcutaneous injection is the standard method for most routine insulin administration in clients with diabetes. However, in the case of hyperglycemia requiring rapid correction, intravenous bolus injection is preferred for faster action.

Choice C:

Intradermal injection is not appropriate for insulin administration. This route is typically used for skin testing or allergen sensitivity assessments, not for delivering insulin.

Choice D:

The nurse should administer regular insulin IV using an intravenous bolus injection in this scenario. When a client with diabetes is admitted to the hospital with hyperglycemia and requires immediate correction of blood sugar levels, intravenous insulin bolus is the most appropriate technique. Intravenous administration allows for rapid action and precise control over insulin dosing.

Choice E:

While an intravenous infusion pump can be used for insulin administration in some situations, it is not the best choice for rapidly correcting hyperglycemia. Intravenous bolus injection provides a more immediate and precise response. Infusion pumps are more commonly used for continuous insulin infusions, such as in critical care settings.

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Question 7:

A client with diabetes is experiencing frequent episodes of hypoglycemia. The nurse should recommend which of the following strategies to prevent hypoglycemic episodes?

A. Increasing carbohydrate intake. B. Skipping meals when not hungry. C. Delaying insulin administration. D. Engaging in intense physical activity. E. Monitoring blood glucose levels more frequently.

Answer and Explanation

Choice A:

Increasing carbohydrate intake may lead to increased blood glucose levels, which is not recommended for a client experiencing frequent hypoglycemic episodes.

Choice B:

Skipping meals when not hungry can lead to erratic blood glucose levels and may worsen the client's hypoglycemic episodes.

Choice C:

Delaying insulin administration is not a safe strategy, as it can result in uncontrolled hyperglycemia and further complications.

Choice D:

Engaging in intense physical activity can lower blood glucose levels, potentially exacerbating the hypoglycemic episodes.

Choice E:

Monitoring blood glucose levels more frequently is essential for clients with diabetes experiencing hypoglycemic episodes. By regularly checking blood glucose levels, the client and healthcare team can identify trends and adjust insulin or medication dosages appropriately, helping to prevent future hypoglycemic episodes.

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Question 8:

A nurse is preparing a patient for chest tube insertion. Which of the following nursing actions should the nurse take during the preparation process?

A. Obtain cultures from the chest tube site before insertion. B. Apply pressure dressing to the wound site after insertion. C. Administer antibiotics to the patient before the procedure. D. Monitor vital signs and pain level after the chest tube insertion. E. Instruct the patient to take deep breaths during the insertion.

Answer and Explanation

Choice A:

Obtaining cultures from the chest tube site before insertion is not a standard nursing action during chest tube preparation. Cultures are usually taken if there is an infection or concern after the insertion.

Choice B:

Applying a pressure dressing to the wound site after chest tube insertion is not a recommended practice. Airtight dressing can lead to tension pneumothorax. Instead, a sterile occlusive dressing is typically applied.

Choice C:

Administering antibiotics to the patient before the procedure is not a standard nursing action during chest tube preparation. Antibiotics are usually prescribed if there is an infection after the insertion.

Choice D:

Monitoring vital signs and pain level after chest tube insertion is essential to assess the patient's response to the procedure and to identify any complications, such as pneumothorax, bleeding, or infection.

Choice E:

Instructing the patient to take deep breaths during the insertion is not appropriate because chest tube insertion is a sterile procedure, and patients are usually not conscious during the process. The insertion site is anesthetized, and deep breaths could compromise sterile technique and increase the risk of infection.

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Question 9:

A nurse is responsible for chest tube care and management. Which of the following actions should the nurse perform to maintain chest tube function? Select all that apply:

A. Keep the drainage system above the chest level. B. Clamp the tubing for an extended period to prevent leaks. C. Ensure adequate and stable water levels in the water-seal and suction-control chambers. D. Milk or strip the tubing regularly to enhance drainage. E. Keep the tubing free of kinks, loops, or dependent areas.

Answer and Explanation

Choice A:

Keeping the drainage system above the chest level is incorrect because the drainage system should be placed below the chest level to facilitate proper drainage of fluids and air.

Choice B:

Clamping the tubing for an extended period to prevent leaks is incorrect. Chest tubes should never be clamped for an extended period as it can lead to a dangerous buildup of pressure within the pleural space and impair proper drainage.

Choice C:

Ensuring adequate and stable water levels in the water-seal and suction-control chambers is correct. Maintaining appropriate water levels is essential for maintaining the proper functioning of the chest tube system, ensuring that it can effectively remove air and fluid from the pleural space.

Choice D:

Milking or stripping the tubing regularly to enhance drainage is incorrect. This practice is outdated and can cause damage to the chest tube, leading to potential complications. The tubing should not be manipulated in this manner.

Choice E:

Keeping the tubing free of kinks, loops, or dependent areas is correct. Any kinks, loops, or dependent areas can obstruct the flow of fluids and air within the chest tube system, impairing its functionality.

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Question 10:

A nurse is caring for a patient with a chest tube and drainage system. The patient reports continuous bubbling in the water-seal chamber. Which of the following statements should the nurse make?

A. "This is a normal finding and does not require any intervention.". B. "Let me clamp the tubing to see if the bubbling stops.". C. "I'll apply an occlusive dressing to seal the wound site.". D. "Notify the physician immediately; there might be an air leak.".

Answer and Explanation

Choice A:

Stating that continuous bubbling in the water-seal chamber is a normal finding and does not require any intervention is incorrect. Continuous bubbling indicates an air leak, and it requires prompt evaluation and intervention.

Choice B:

Clamping the tubing to see if the bubbling stops is incorrect. Clamping the tubing would only be done to assess if the air leak is from the patient or the system, but it does not address the underlying issue.

Choice C:

Applying an occlusive dressing to seal the wound site is incorrect. While dressing changes may be necessary to maintain a sterile environment, it will not resolve the air leak causing continuous bubbling.

Choice D:

Notifying the physician immediately about the air leak is the appropriate nursing action. Continuous bubbling in the water-seal chamber suggests an air leak, which could compromise the effectiveness of the chest tube and require immediate medical attention.

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Question 11:

A client with a chest tube reports severe dyspnea, absent breath sounds on the affected side, and jugular venous distension. The nurse assesses increased intrathoracic pressure. What is the appropriate nursing action?

A. Administer diuretics to reduce the fluid accumulation. B. Prepare for needle decompression or chest tube insertion. C. Position the client in a Trendelenburg position to facilitate breathing. D. Instruct the client to take slow, deep breaths to prevent further complications.

Answer and Explanation

Choice A:

Administering diuretics to reduce fluid accumulation is incorrect. Severe dyspnea, absent breath sounds, and jugular venous distension indicate a potential tension pneumothorax or hemothorax, which requires prompt action, and diuretics would not address the underlying issue.

Choice B:

Preparing for needle decompression or chest tube insertion is the appropriate nursing action. The client's symptoms of severe dyspnea, absent breath sounds, jugular venous distension, and increased intrathoracic pressure suggest a possible tension pneumothorax or hemothorax. Immediate decompression with a large-bore needle or insertion of a chest tube is necessary to relieve pressure and restore lung function.

Choice C:

Positioning the client in a Trendelenburg position to facilitate breathing is incorrect. In the case of increased intrathoracic pressure, this position can further compromise respiratory function and is not recommended.

Choice D:

Instructing the client to take slow, deep breaths to prevent further complications is incorrect. The client's condition requires urgent medical intervention, and slow, deep breaths would not address the acute issue of increased intrathoracic pressure and compromised lung function.

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Question 12:

A nurse is educating a patient and their family about chest tube care. What instructions should the nurse include?

A. "You should keep the drainage system below the chest level at all times.". B. "Deep breathing and coughing exercises are not necessary while the chest tube is in place.". C. "Notify the physician immediately if you observe any subcutaneous emphysema around the chest tube site.". D. "You can expect the drainage color to change from serosanguineous to bright red during the recovery process.".

Answer and Explanation

Choice A:

The nurse should instruct the patient and their family to keep the drainage system below the chest level at all times. This positioning helps ensure proper drainage of fluid or air from the chest, preventing any backflow or obstruction in the system. Gravity assists in maintaining the drainage flow, promoting the effectiveness of the chest tube.

Choice B:

Deep breathing and coughing exercises are essential while the chest tube is in place. These exercises help prevent complications such as atelectasis and pneumonia by promoting lung expansion and clearing secretions. The patient should be encouraged to perform these exercises as directed by the healthcare provider.

Choice C:

The nurse should educate the patient and their family to notify the physician immediately if they observe any subcutaneous emphysema around the chest tube site. Subcutaneous emphysema is a potential complication of chest tube placement, indicating air leakage into the tissues. Prompt notification allows for timely intervention to prevent further complications.

Choice D:

The nurse should inform the patient that the drainage color may change from serosanguineous (pale, pink, or slightly bloody) to bright red during the recovery process. Initially, the drainage may be bloody, but as healing progresses, it should become clearer. However, if the drainage suddenly becomes bright red, it could indicate active bleeding, and the healthcare provider should be notified immediately.

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Question 13:

A client with a chest tube shows signs of infection, such as fever, chills, increased white blood cell count, and purulent drainage. What intervention should the nurse prioritize?

A. Apply a pressure dressing to the wound site. B. Obtain cultures from the chest tube site. C. Administer oxygen to improve ventilation. D. Monitor the client's vital signs and oxygen saturation.

Answer and Explanation

Choice A:

Applying a pressure dressing to the wound site is not the priority intervention for a chest tube with signs of infection. The primary concern is to address the infection and prevent its spread.

Choice B:

The nurse should prioritize obtaining cultures from the chest tube site to identify the causative organism responsible for the infection. This information will guide the selection of appropriate antibiotics to treat the infection effectively.

Choice C:

Administering oxygen to improve ventilation may be beneficial for some patients, but it does not address the underlying infection. Oxygen therapy can support respiratory function but is not the priority intervention in this situation.

Choice D:

Monitoring vital signs and oxygen saturation is essential but does not address the infection directly. Vital sign monitoring is ongoing, while obtaining cultures is a specific intervention targeted at the suspected infection.

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Question 14:

A nurse caring for a patient with a chest tube notices a sudden decrease in drainage with pink frothy sputum and crackles on auscultation. What condition should the nurse suspect, and what intervention is appropriate?

A. Tension pneumothorax; prepare for chest tube insertion on the affected side. B. Subcutaneous emphysema; monitor respiratory status and elevate the head of the bed. C. Re-expansion pulmonary edema; administer diuretics as ordered. D. Infection; notify the physician and obtain cultures from the chest tube site.

Answer and Explanation

Choice A:

The nurse should suspect tension pneumothorax in the patient with a chest tube who shows sudden decreased drainage, pink frothy sputum, and crackles on auscultation. Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, leading to increased pressure on the affected lung and heart. Immediate intervention, such as chest tube insertion on the affected side, is crucial to relieve the pressure and improve ventilation.

Choice B:

Subcutaneous emphysema does not present with decreased drainage or pink frothy sputum. It is characterized by air trapped under the skin, causing a crackling sensation on palpation. Monitoring respiratory status and elevating the head of the bed are appropriate interventions for subcutaneous emphysema but not in this scenario.

Choice C:

Re-expansion pulmonary edema is a rare complication that occurs after rapid lung re-expansion. It does not typically manifest with pink frothy sputum and crackles. Administering diuretics may be appropriate, but it is not the primary intervention in this situation.

Choice D:

Infection does not explain the sudden decrease in drainage and pink frothy sputum. Although obtaining cultures from the chest tube site is important to assess for infection, it is not the most appropriate intervention at this moment. The priority is to address the potential tension pneumothorax.

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Question 15:

A nurse is preparing to remove a chest tube from a patient. Which of the following actions should the nurse take during the removal procedure? Select all that apply:

A. Obtain a physician's order and informed consent from the patient. B. Instruct the patient to exhale forcefully during the removal. C. Monitor the patient's respiratory status and vital signs after the removal. D. Apply an occlusive dressing with petroleum gauze over the wound site after removal.

Answer and Explanation

Choice A:

The nurse should obtain a physician's order and informed consent from the patient before removing the chest tube. Rationale: Chest tube removal is a medical procedure that requires a physician's order, and obtaining informed consent ensures that the patient is aware of the procedure and its potential risks.

Choice B:

Instructing the patient to exhale forcefully during the removal is not necessary and may even be harmful. Rationale: The Valsalva maneuver, which involves forceful exhalation, can increase intrathoracic pressure and may lead to complications like pneumothorax during chest tube removal. Therefore, this action should be avoided.

Choice C:

Monitoring the patient's respiratory status and vital signs after the removal is essential. Rationale: After chest tube removal, it is crucial to monitor the patient for signs of respiratory distress, such as shortness of breath or decreased oxygen saturation, and vital signs to detect any complications promptly.

Choice D:

Applying an occlusive dressing with petroleum gauze over the wound site after removal is not the standard practice. Rationale: After chest tube removal, the wound site is typically left open to allow for the drainage of any residual air or fluid. Applying an occlusive dressing can trap air or fluid, leading to complications.

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Chest tubes

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