Pleural Disorders Quiz Number 2 PDF

**Pleural Disorders Quiz Number 2:** **1. The nurse is assessing a patient with suspected pleural effusion. Which clinical manifestation is most consistent with this diagnosis?** A\) Hyperresonance on percussion\ B) Diminished breath sounds\ C) Increased fremitus\ D) Barking cough **Answer: B) Di...

**Pleural Disorders Quiz Number 2:** **1. The nurse is assessing a patient with suspected pleural effusion. Which clinical manifestation is most consistent with this diagnosis?** A\) Hyperresonance on percussion\ B) Diminished breath sounds\ C) Increased fremitus\ D) Barking cough **Answer: B) Diminished breath sounds**\ **Rationale:** Pleural effusion leads to fluid accumulation in the pleural space, reducing lung expansion and causing diminished or absent breath sounds. Fremitus is decreased, not increased. **2. A patient with a hemothorax is scheduled for a chest tube insertion. What is the primary purpose of the chest tube in this scenario?** A\) Drain accumulated air\ B) Prevent fluid overload\ C) Remove blood and restore lung expansion\ D) Deliver oxygen directly into the pleural space **Answer: C) Remove blood and restore lung expansion**\ **Rationale:** A chest tube drains blood from the pleural space, allowing lung re-expansion. It does not deliver oxygen or prevent systemic fluid overload. **3. Which of the following is a hallmark sign of a tension pneumothorax?** A\) Tracheal deviation to the unaffected side\ B) Bilateral wheezing\ C) Decreased respiratory rate\ D) Peripheral cyanosis **Answer: A) Tracheal deviation to the unaffected side**\ **Rationale:** Tension pneumothorax causes mediastinal shift due to increased intrapleural pressure. This shift moves the trachea away from the affected lung. **4. Which condition is most commonly associated with a transudative pleural effusion?** A\) Tuberculosis\ B) Pulmonary embolism\ C) Congestive heart failure\ D) Bacterial pneumonia **Answer: C) Congestive heart failure**\ **Rationale:** Transudative pleural effusion is caused by systemic factors like heart failure, leading to fluid leakage due to increased hydrostatic pressure. **5. A nurse is preparing a patient for thoracentesis. Which action is the priority?** A\) Positioning the patient sitting upright and leaning forward\ B) Administering sedatives before the procedure\ C) Encouraging deep breathing during the procedure\ D) Keeping the patient NPO for six hours **Answer: A) Positioning the patient sitting upright and leaning forward**\ **Rationale:** This position allows fluid to accumulate in the lower pleural cavity, facilitating aspiration. **6. Which intervention is appropriate for a patient with a pneumothorax receiving a chest tube?** A\) Keeping the collection chamber above chest level\ B) Clamping the chest tube routinely\ C) Assessing for continuous bubbling in the water seal chamber\ D) Removing the chest tube when drainage exceeds 500 mL **Answer: C) Assessing for continuous bubbling in the water seal chamber**\ **Rationale:** Continuous bubbling suggests an air leak that needs investigation. The collection chamber should always remain below chest level. **7. A patient with pleurisy reports sharp, stabbing chest pain. What intervention should the nurse prioritize?** A\) Encourage deep breathing and coughing\ B) Position the patient on the affected side\ C) Administer IV fluids\ D) Encourage rapid breathing **Answer: B) Position the patient on the affected side**\ **Rationale:** Lying on the affected side reduces pleural friction and pain. **8. Which diagnostic test is most commonly used to confirm a pleural effusion?** A\) Chest X-ray\ B) Pulmonary function test\ C) Arterial blood gas\ D) Bronchoscopy **Answer: A) Chest X-ray**\ **Rationale:** Chest X-rays can identify fluid accumulation in the pleural space. **9. What is the most critical initial action for a patient with suspected tension pneumothorax?** A\) Obtain a chest X-ray\ B) Prepare for needle decompression\ C) Administer an albuterol nebulizer\ D) Insert a large-bore IV **Answer: B) Prepare for needle decompression**\ **Rationale:** Tension pneumothorax is a medical emergency requiring immediate decompression to relieve pressure. **10. Which statement indicates effective patient teaching about home care with a chest tube?** A\) "I will clamp the tube when walking to the bathroom."\ B) "I should report any sudden increase in drainage."\ C) "Bubbling in the water seal chamber means my lung has healed."\ D) "I should milk the tubing frequently to prevent clots." **Answer: B) "I should report any sudden increase in drainage."**\ **Rationale:** A sudden increase in drainage may indicate hemorrhage or worsening condition. **11. A nurse is assessing a patient with a pneumothorax. Which breath sound finding is expected?** A\) Crackles\ B) Stridor\ C) Absent breath sounds on the affected side\ D) Coarse wheezing **Answer: C) Absent breath sounds on the affected side**\ **Rationale:** Air in the pleural space prevents lung expansion, leading to absent breath sounds. **12. The primary goal of treatment for pleural disorders is to:** A\) Strengthen respiratory muscles\ B) Restore negative intrapleural pressure\ C) Prevent aspiration pneumonia\ D) Decrease mucus production **Answer: B) Restore negative intrapleural pressure**\ **Rationale:** Negative pressure is necessary for lung expansion. **13. Which patient is at highest risk for developing a primary spontaneous pneumothorax?** A\) A 70-year-old with chronic bronchitis\ B) A 22-year-old tall, thin male who smokes\ C) A 50-year-old post-cardiac surgery patient\ D) A 45-year-old with asthma **Answer: B) A 22-year-old tall, thin male who smokes**\ **Rationale:** Spontaneous pneumothorax often occurs in young, thin males due to alveolar rupture. **14. A patient with a chest tube develops subcutaneous emphysema. What action should the nurse take?** A\) Apply a warm compress to the site\ B) Assess for tube dislodgment or air leaks\ C) Clamp the chest tube\ D) Increase the suction pressure **Answer: B) Assess for tube dislodgment or air leaks**\ **Rationale:** Subcutaneous emphysema suggests air leakage, requiring assessment of the chest tube system. **15. Which assessment finding suggests pleuritic pain rather than cardiac pain?** A\) Pain radiates to the left arm\ B) Pain worsens with deep breathing\ C) Pain improves with rest\ D) Pain occurs with exertion **Answer: B) Pain worsens with deep breathing**\ **Rationale:** Pleuritic pain is sharp and worsens with respiration due to pleural inflammation. **16. A patient with a history of lung cancer develops dyspnea and dullness to percussion over the left lower lung field. Which condition is most likely?** A\) Pneumothorax\ B) Pleural effusion\ C) Emphysema\ D) Bronchitis **Answer: B) Pleural effusion**\ **Rationale:** Dullness to percussion suggests fluid accumulation, which is characteristic of pleural effusion. Pneumothorax would cause hyperresonance. **17. What is the priority nursing action for a patient with a newly inserted chest tube?** A\) Clamp the tube for the first 2 hours\ B) Position the drainage system above chest level\ C) Assess for an air leak in the water seal chamber\ D) Remove the dressing after 12 hours **Answer: C) Assess for an air leak in the water seal chamber**\ **Rationale:** Air leaks can indicate improper tube placement or ongoing air accumulation, which must be addressed immediately. **18. Which patient has the highest risk for developing empyema?** A\) A patient with viral bronchitis\ B) A patient with bacterial pneumonia\ C) A patient with chronic asthma\ D) A patient with pulmonary hypertension **Answer: B) A patient with bacterial pneumonia**\ **Rationale:** Empyema is pus accumulation in the pleural space, often due to bacterial pneumonia. **19. What is the primary purpose of pleurodesis in a patient with recurrent pleural effusions?** A\) Remove excess pleural fluid\ B) Prevent fluid reaccumulation\ C) Repair damaged lung tissue\ D) Improve respiratory muscle strength **Answer: B) Prevent fluid reaccumulation**\ **Rationale:** Pleurodesis uses an irritant (e.g., talc) to fuse pleural layers and prevent further effusions. **20. The nurse notes continuous bubbling in the suction control chamber of a chest drainage system. What does this indicate?** A\) Normal function\ B) Air leak in the system\ C) Lung re-expansion\ D) Blockage in the chest tube **Answer: A) Normal function**\ **Rationale:** The suction control chamber should have continuous bubbling, while intermittent bubbling in the water seal chamber is expected. Continuous bubbling in the water seal chamber, however, indicates an air leak. **21. What assessment finding is expected in a patient with a hemothorax?** A\) Decreased breath sounds on the affected side\ B) Hyperresonance to percussion\ C) Increased fremitus\ D) Stridor **Answer: A) Decreased breath sounds on the affected side**\ **Rationale:** Blood accumulation in the pleural space prevents proper lung expansion, leading to diminished breath sounds. **22. A patient presents with acute dyspnea, tracheal deviation to the right, and absent breath sounds on the left. What is the nurse's priority intervention?** A\) Obtain a stat chest X-ray\ B) Administer albuterol\ C) Perform needle decompression\ D) Place the patient in a high Fowler's position **Answer: C) Perform needle decompression**\ **Rationale:** Tracheal deviation suggests a **tension pneumothorax**, requiring emergency needle decompression to relieve pressure. **23. The nurse is reviewing chest tube management with a student. Which statement indicates the student needs further teaching?** A\) "I will keep the drainage system below chest level."\ B) "I will clamp the tube before ambulating the patient."\ C) "I will encourage the use of an incentive spirometer."\ D) "I will assess for subcutaneous emphysema around the insertion site." **Answer: B) "I will clamp the tube before ambulating the patient."**\ **Rationale:** Chest tubes should not be clamped unless specifically ordered by a provider, as this can lead to tension pneumothorax. **24. A patient is diagnosed with a spontaneous pneumothorax. Which finding would the nurse expect?** A\) Bradycardia\ B) Sudden onset of dyspnea and pleuritic chest pain\ C) Frothy sputum\ D) Bilateral lung crackles **Answer: B) Sudden onset of dyspnea and pleuritic chest pain**\ **Rationale:** Spontaneous pneumothorax often presents with acute dyspnea and sharp chest pain due to lung collapse. **25. A patient with a pleural disorder is receiving oxygen therapy. What is the best indicator of effective oxygenation?** A\) Increased respiratory rate\ B) Decreased use of accessory muscles\ C) Pulse oximetry reading above 92%\ D) Absence of abnormal breath sounds **Answer: C) Pulse oximetry reading above 92%**\ **Rationale:** Oxygenation is best assessed through objective measures like **SpO2 levels**. **26. Which sign differentiates a tension pneumothorax from a simple pneumothorax?** A\) Sudden onset of sharp chest pain\ B) Decreased breath sounds on the affected side\ C) Tracheal deviation\ D) Mild respiratory distress **Answer: C) Tracheal deviation**\ **Rationale:** Tension pneumothorax causes a **mediastinal shift**, pushing the trachea to the unaffected side. **27. Which finding suggests a complication of a thoracentesis?** A\) Increased blood pressure\ B) Crepitus around the puncture site\ C) Increased oxygen saturation\ D) Increased urine output **Answer: B) Crepitus around the puncture site**\ **Rationale:** Crepitus suggests subcutaneous emphysema, which can occur if air leaks into the tissue. **28. The nurse assesses a patient after a chest tube removal. Which finding requires immediate intervention?** A\) Small amount of serous drainage at the insertion site\ B) Pulse oximetry reading of 98%\ C) Diminished breath sounds on the affected side\ D) Sudden severe respiratory distress **Answer: D) Sudden severe respiratory distress**\ **Rationale:** This could indicate **recurrent pneumothorax** and requires immediate evaluation. **29. What is the best method to confirm lung re-expansion after chest tube placement?** A\) Chest X-ray\ B) Decreased chest tube drainage\ C) Absence of bubbling in the water seal chamber\ D) Improvement in breath sounds **Answer: A) Chest X-ray**\ **Rationale:** A chest X-ray provides visual confirmation of lung re-expansion. **30. Which patient is at greatest risk for developing a tension pneumothorax?** A\) A patient on mechanical ventilation\ B) A patient with a history of smoking\ C) A patient with pneumonia\ D) A patient with stable COPD **Answer: A) A patient on mechanical ventilation**\ **Rationale:** High-pressure ventilation can cause **barotrauma**, leading to **tension pneumothorax**. **31. The nurse is caring for a patient with a chest tube following a pneumothorax. Which assessment requires immediate action?** A\) Serosanguineous drainage of 50 mL in 8 hours\ B) Intermittent bubbling in the water seal chamber\ C) Tracheal deviation to the opposite side\ D) Mild pain at the insertion site **Answer: C) Tracheal deviation to the opposite side**\ **Rationale:** Tracheal deviation suggests a **tension pneumothorax**, requiring **emergency intervention**. **32. A nurse is caring for a patient with empyema. Which intervention is the priority?** A\) Administering broad-spectrum antibiotics\ B) Encouraging deep breathing exercises\ C) Positioning the patient in a high Fowler's position\ D) Monitoring daily weight **Answer: A) Administering broad-spectrum antibiotics**\ **Rationale:** Empyema is a collection of pus in the pleural space, often due to bacterial infection. **Antibiotic therapy** is the **priority** to treat the infection. **33. A patient has a chest tube inserted for a pneumothorax. The nurse notes that the water seal chamber has no bubbling. What is the most appropriate action?** A\) Assess the tube for kinks or obstructions\ B) Increase suction pressure\ C) Clamp the chest tube\ D) Immediately remove the chest tube **Answer: A) Assess the tube for kinks or obstructions**\ **Rationale:** A lack of bubbling may indicate a **blocked tube** or that the pneumothorax has resolved. The nurse should check for kinks before taking further action. **34. The nurse is caring for a patient post-thoracotomy. Which intervention is the most important for preventing pulmonary complications?** A\) Administering opioids as prescribed\ B) Encouraging incentive spirometer use\ C) Monitoring incision site for drainage\ D) Keeping the patient in a supine position **Answer: B) Encouraging incentive spirometer use**\ **Rationale:** **Incentive spirometry** helps prevent **atelectasis** and improves lung expansion after surgery. **35. Which nursing intervention is most appropriate for a patient with pleurisy?** A\) Encourage ambulation and weight lifting\ B) Encourage deep breathing and splinting the chest\ C) Apply ice packs to the chest\ D) Instruct the patient to lie flat **Answer: B) Encourage deep breathing and splinting the chest**\ **Rationale:** Pleurisy causes sharp pain during respiration, and **splinting with a pillow** reduces discomfort while deep breathing prevents complications. **36. A patient with a hemothorax is receiving a blood transfusion. Which finding requires the nurse to stop the transfusion immediately?** A\) Mild back pain and fever\ B) Increased urinary output\ C) Urticaria and hypotension\ D) Slight discomfort at the IV site **Answer: C) Urticaria and hypotension**\ **Rationale:** These signs indicate a **transfusion reaction**, which can be life-threatening. **37. A nurse is monitoring a patient with a chest tube. Which finding is concerning?** A\) 75 mL of drainage in the last 8 hours\ B) Intermittent bubbling in the water seal chamber\ C) Continuous bubbling in the water seal chamber\ D) The chest drainage system is below chest level **Answer: C) Continuous bubbling in the water seal chamber**\ **Rationale:** Continuous bubbling in the **water seal chamber** indicates an **air leak** that must be assessed. **38. A nurse is assessing a patient after a thoracentesis. Which finding is most concerning?** A\) Decreased blood pressure and tachycardia\ B) Mild discomfort at the puncture site\ C) Small amount of serous drainage\ D) Increased oxygen saturation **Answer: A) Decreased blood pressure and tachycardia**\ **Rationale:** These signs suggest **hypovolemic shock** due to excessive fluid removal or bleeding. **39. The nurse is preparing a patient for talc pleurodesis. What is the primary purpose of this procedure?** A\) Treat pleural infections\ B) Remove excess air from the pleural space\ C) Create adhesions between pleural layers\ D) Drain excess blood from the pleural space **Answer: C) Create adhesions between pleural layers**\ **Rationale:** **Pleurodesis** prevents **recurrent pleural effusions or pneumothorax** by **fusing the pleural layers together**. **40. A nurse is caring for a patient with a chest tube post-lobectomy. Which finding is most concerning?** A\) 50 mL of serosanguineous drainage over 6 hours\ B) Fluctuation in the water seal chamber with respiration\ C) Sudden cessation of drainage\ D) The patient reporting mild pain at the insertion site **Answer: C) Sudden cessation of drainage**\ **Rationale:** **A sudden stop in drainage** may indicate **tube obstruction**, requiring immediate assessment. **41. The nurse is teaching a patient about prevention of spontaneous pneumothorax recurrence. Which statement indicates effective teaching?** A\) "I should avoid smoking and high altitudes."\ B) "I should take deep breaths to prevent lung collapse."\ C) "I need to avoid fluids before bedtime."\ D) "I should increase my salt intake." **Answer: A) "I should avoid smoking and high altitudes."**\ **Rationale:** Smoking and rapid pressure changes **increase the risk of recurrence**. **42. The nurse is evaluating a patient for a pleural disorder. Which diagnostic test is most definitive?** A\) Arterial blood gas\ B) Sputum culture\ C) Chest X-ray\ D) Thoracentesis with fluid analysis **Answer: D) Thoracentesis with fluid analysis**\ **Rationale:** **Thoracentesis** determines the **cause of pleural effusion** by analyzing fluid characteristics. **43. A patient with a pleural effusion is scheduled for thoracentesis. What is the correct patient positioning?** A\) Supine with arms at the sides\ B) Sitting upright, leaning forward\ C) Trendelenburg position\ D) Side-lying on the affected side **Answer: B) Sitting upright, leaning forward**\ **Rationale:** This position allows **easier fluid drainage** from the pleural space. **44. What is the best method for preventing pleural infections after chest surgery?** A\) Early ambulation and deep breathing\ B) Frequent suctioning\ C) Increased IV fluid intake\ D) Placing the patient in a Trendelenburg position **Answer: A) Early ambulation and deep breathing**\ **Rationale:** **Postoperative lung expansion** helps **prevent pneumonia and empyema**. **45. A nurse is assessing a patient with a suspected pneumothorax. Which vital sign change is expected?** A\) Hypertension\ B) Bradycardia\ C) Tachypnea\ D) Decreased temperature **Answer: C) Tachypnea**\ **Rationale:** A collapsed lung reduces oxygenation, leading to **increased respiratory rate**. **46. What is a key indication for chest tube removal?** A\) Continuous bubbling in the water seal chamber\ B) Increased drainage output\ C) Absence of bubbling in the water seal chamber\ D) Presence of crepitus **Answer: C) Absence of bubbling in the water seal chamber**\ **Rationale:** No bubbling suggests **resolution of air leak** or **lung re-expansion**. **47. A patient with COPD is at risk for which type of pneumothorax?** A\) Primary spontaneous\ B) Secondary spontaneous\ C) Iatrogenic\ D) Traumatic **Answer: B) Secondary spontaneous**\ **Rationale:** COPD causes **lung damage**, increasing the risk for **spontaneous pneumothorax**. **48. Which intervention is most appropriate for a patient with pleural effusion-related dyspnea?** A\) Encourage ambulation\ B) Elevate the head of the bed\ C) Apply ice packs to the chest\ D) Encourage fluid restriction **Answer: B) Elevate the head of the bed**\ **Rationale:** **Raising the head of the bed** improves lung expansion and oxygenation. **49. A patient develops tension pneumothorax while on mechanical ventilation. What is the priority action?** A\) Increase tidal volume\ B) Perform needle decompression\ C) Administer a bronchodilator\ D) Decrease oxygen flow **Answer: B) Perform needle decompression**\ **Rationale:** **Tension pneumothorax** is life-threatening and requires **emergency needle decompression**. **50. What is the primary goal of chest tube therapy?** A\) Drain fluid or air from the pleural space\ B) Increase lung compliance\ C) Prevent infection\ D) Improve venous return **Answer: A) Drain fluid or air from the pleural space**\ **Rationale:** Chest tubes **restore negative intrapleural pressure**, allowing **lung re-expansion**.