Chest Tube and Parenteral Nutrition Quiz

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Questions and Answers

What should be done if the chest tube disconnects from the drainage unit?

Instruct the patient to exhale and cough, then immerse the open end in sterile saline. (correct)

Clamp the chest tube to prevent air entering.

Replace the drainage unit without patient intervention.

Notify the healthcare provider immediately.

What is the expected color of drainage from a chest tube within the first three hours post-operatively?

Clear and serous.

Dark brown.

Cloudy and opaque.

Bright red. (correct)

How often should the color, amount, and consistency of drainage be assessed post insertion?

Every hour for the first 3 hours.

Every 15 minutes for the first 2 hours. (correct)

Every 30 minutes for the first 6 hours.

Every 2 hours after the first assessment.

What is the proper position for a chest drainage unit in relation to the patient's chest?

Upright and below the patient's chest. Signup and view all the answers

What should not be done with a chest tube to prevent complications?

Routine clamping. Signup and view all the answers

What is the most critical reason for using Total Parenteral Nutrition (TPN)?

Patients need to rest their bowel. Signup and view all the answers

Which of the following is NOT a necessary step when administering TPN through a central line?

Change the bag every 48 hours. Signup and view all the answers

What should be done if a 3-in-1 TPN bag shows oil droplets or a creamy layer?

Return the bag to the pharmacy. Signup and view all the answers

For patients receiving Peripheral Parenteral Nutrition (PPN), what is the maximum duration for which it should be administered?

2 weeks Signup and view all the answers

What is the main concern when using TPN regarding potential complications?

High risk of infections. Signup and view all the answers

What is a benefit of brushing teeth at least twice a day?

It helps remove plaque and bacteria. Signup and view all the answers

Which type of exercises involves muscle contraction without shortening?

Isometric exercises Signup and view all the answers

Why should lemon-glycerin sponges be avoided in oral care?

They may irritate the oral mucosa. Signup and view all the answers

What type of exercise significantly improves muscle mass and joint mobility?

Isotonic exercises Signup and view all the answers

What precaution should be taken for unconscious patients regarding oral care?

Turn them on their side to prevent aspiration. Signup and view all the answers

Which oral care product is recommended for critically ill patients to reduce pneumonia risk?

Chlorhexidine gluconate oral spray Signup and view all the answers

Which of the following describes the principle of ergonomics to prevent injury while lifting?

Face the direction of movement and lower your center of gravity. Signup and view all the answers

Flossing helps to address which dental concern?

Tartar removal at the gum line. Signup and view all the answers

What is the primary goal in managing Respiratory Alkalosis?

Raise carbon dioxide levels Signup and view all the answers

What pH value indicates Metabolic Acidosis?

7.35 or lower Signup and view all the answers

Which of the following symptoms is commonly associated with Respiratory Alkalosis?

Tetany Signup and view all the answers

In cases of Metabolic Acidosis, which nursing intervention is crucial?

Administer insulin for DKA Signup and view all the answers

What would be an expected bicarbonate level in metabolic acidosis?

< 22 mEq/L Signup and view all the answers

Which condition can lead to Respiratory Alkalosis due to hyperventilation?

Sepsis Signup and view all the answers

What physiological response is seen in the kidneys during respiratory alkalosis?

Retaining hydrogen and excreting bicarbonate Signup and view all the answers

Which of the following assessments would likely indicate severe metabolic acidosis?

Coma or lethargy Signup and view all the answers

What type of ostomy involves the creation of a stoma in the ileum?

Ileostomy Signup and view all the answers

Which type of ostomy is typically most solid in stool consistency?

Descending colostomy Signup and view all the answers

Which of the following points is not included in the informed consent process?

Names of all surgical team members Signup and view all the answers

Who can administer sedation before the signing of an informed consent form?

No one should administer sedation Signup and view all the answers

A patient must have the right to refuse treatment unless which condition is met?

A court has legally determined incompetency Signup and view all the answers

What is a key characteristic of faecal effluent from an ileostomy?

Frequent and liquid to pasty Signup and view all the answers

Which of the following statements about informed consent is incorrect?

Consent forms can be legal for unconscious patients. Signup and view all the answers

What bowel disorder can lead to the necessity of creating an ostomy?

Inflammatory bowel disease Signup and view all the answers

What is the primary difference between medical and surgical asepsis?

Medical asepsis reduces the spread of microorganisms. Signup and view all the answers

In which order should personal protective equipment (PPE) be donned?

Gown, mask, goggles, gloves Signup and view all the answers

Which of the following is a key principle of surgical asepsis?

Only sterile objects may touch a sterile field. Signup and view all the answers

What does a red color classification in wound evaluation indicate?

The area is healthy with granulation tissue. Signup and view all the answers

What is the appropriate action for yellow-colored slough in wound care?

Cleanse the area and monitor for infection. Signup and view all the answers

In primary intention healing, what is characteristic of the wound?

Wound edges are well approximated with minimal scarring. Signup and view all the answers

Which moment of hand hygiene should occur after touching patient surroundings?

Moment 5 Signup and view all the answers

What does 'B' in the RYB classification of wounds stand for?

Black eschar requires debridement Signup and view all the answers

Study Notes

Lab Values

Sodium: 136-145 mEq/L (values based on shared email)
Calcium: 9-10.5 mg/dL (values based on shared email)
BUN: 8-20 mg/dL
Magnesium: 1.5-2.4 mEq/L
Hematocrit: 36-51%

Hypocalcemia

Chvostek and Trousseau signs
Muscle cramps
Laryngospasm

Hyperkalemia

Peak/tall T wave, widened QRS

Important Information from Lab Tests

BUN: reveals kidney function
Liver produces urea as a waste product
Magnesium levels: 1.5 - 2.4

Dehydration

Hypernatremia is seen in dehydration
Three parameters: (from page 69)
ABG and Acid-Base Balance
Inverse relationship between calcium and phosphorus

Pain Management

PCA (patient-controlled analgesia)
Types of masks for oxygen such as non-rebreather
Non-rebreather percentage: 90-100%
Considerations for bag (non-rebreather): partially inflated, never deflated; O2 saturation should increase; rubberized flap

Critical Thinking/Clinical Reasoning

Includes interpretation, analysis, evaluation, inference, and explanation
Leads to clinical judgments.
Active and orderly reasoning, applies knowledge and experience
Problem-solving, logic, reasoning, and decision-making

Patient Safety

Neonates/infants: crib rails/monitor constantly, car seat (all 50 states)
Toddlers & preschoolers: safety hazards
School-aged children: safety during activities
Adolescents: issues such as drunk driving
Adults: lifestyle habits, violence, medication concerns
Older adults: falls, accidents, cognitive changes.
Environment: impaired mobility, impaired senses, awareness

ABCs (Airway, Breathing, Circulation)

Physiologic needs - Maslow's hierarchy

Infection Control/Asepsis

Medical Asepsis: reducing pathogen numbers/transfer; used consistently in and outside health facilities
Surgical Asepsis: sterile techniques; procedures to maintain sterility (e.g., IV, catheter insertion)

Transmission Based Precautions

Blood, body fluids, secretions, excretions (except sweat, non-intact skin, and mucous membranes)- use universal precautions
Hand hygiene - alcohol-based waterless products (recommended/visibly soiled or contaminated)
Hand wash with soap and water if contamination with spores is suspected
Use soap and water for visibly soiled or contaminated with body fluids

Patient Centered Care

Maslow's hierarchy-needs (Physiological; Safety; Belongingness and Love; Esteem; Self-actualization)

Restraints

Use only as a last resort.
Must be reviewed/approved by physician.
Appropriate documentation is required (Include reason, behavior prior to use, and alternatives attempted)

Preventing Falls/Safety

Establish a clear strategy to address call lights and alarms
Ensure clear pathways, minimize clutter, use nightlights.
Keep patient within arms reach
Use proper assistive devices and safety features
Monitor patients closely and ensure adequate staffing
Avoid diuretics at night; Educate patient on proper use of call system

Delegation

RN responsible for outcome.
RN must assess if the task is transferable.
UAP should not perform an independent task; or tasks related to patient assessment or clinical judgment.

Patient Monitoring

Signs of injury related to restraints or seclusion
Nutrition and hydration
Circulation
Vital signs
Elimination (urine/bowel)
Hygiene, and comfort
Physical and psychological state
Discharge readiness

Restraint Standards

Clinical justification for restraint use.
Must be time dated.
Include type of restraint, reason, intended duration, criteria for removal by the physician.

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Description

This quiz covers essential knowledge regarding chest tubes and total parenteral nutrition (TPN). Questions include management of chest tube complications, drainage assessment, and key protocols for TPN administration. Test your understanding of these critical medical concepts.