Chapter 30: Pleural Effusion & Empyema

Question 1

Which of the following best describes a pleural effusion?

A. A disease of the pleural membrane

B. A condition caused by decreased pulmonary capillary pressure

C. A disease primarily affecting the lymphatic system

D. An abnormal collection of fluid in the pleural space

Answer 1

D. An abnormal collection of fluid in the pleural space

Rationale: A pleural effusion is not a disease but a sign of another condition, characterized by the abnormal accumulation of fluid in the pleural space.

Question 2

A nurse is caring for a patient with a pleural effusion. Which factor is most likely to cause the fluid accumulation in the pleural space?

A. Decreased pulmonary capillary pressure
B. Increased oncotic pressure
C. Decreased capillary membrane permeability
D. Obstruction of lymphatic flow

Answer 2

D. Obstruction of lymphatic flow

Rationale: Fluid accumulation in the pleural space can occur due to obstruction of lymphatic flow, which impairs the drainage of fluid from the pleural space.

Question 3

A pleural effusion occurs when there is an imbalance in which of the following pressures?

A. Hydrostatic pressure and interstitial pressure

B. Oncotic pressure and pulmonary capillary pressure

C. Hydrostatic pressure, oncotic pressure, and capillary membrane permeability

D. Pulmonary capillary pressure and lymphatic flow

Answer 3

C. Hydrostatic pressure, oncotic pressure, and capillary membrane permeability

Rationale: The balance between hydrostatic pressure, oncotic pressure, and capillary membrane permeability governs fluid movement in and out of the pleural space. An imbalance leads to fluid accumulation.

Question 4

Which of the following conditions can result in pleural effusion?

A. Decreased oncotic pressure
B. Obstruction of the bronchial tubes
C. Increased lung compliance
D. Decreased pleural membrane permeability

Answer 4

A. Decreased oncotic pressure

Rationale: Decreased oncotic pressure can lead to fluid accumulation in the pleural space, contributing to the development of pleural effusion.

Question 5

A nurse is educating a patient about pleural effusion. The nurse should explain that pleural effusion is often a sign of:

A. A primary lung disease
B. An underlying condition affecting fluid balance
C. A bacterial infection of the lungs
D. A problem with airway obstruction

Answer 5

B. An underlying condition affecting fluid balance

Rationale: Pleural effusion is not a primary lung disease but a sign of an underlying condition, often one that disrupts fluid balance in the pleural space.

Question 6

In a patient with pleural effusion, which of the following changes in the capillary system is most likely to lead to fluid accumulation in the pleural space?

A. Increased pulmonary capillary pressure
B. Increased lymphatic flow
C. Decreased hydrostatic pressure
D. Decreased oncotic pressure

Answer 6

B. Increased lymphatic flow

Rationale: Increased pulmonary capillary pressure can lead to fluid accumulation in the pleural space, as it causes an imbalance in fluid movement across the capillary membrane.

Question 7

A nurse is caring for a patient with a transudative pleural effusion. Which of the following characteristics is most likely to be seen in the fluid?

A. High protein content
B. Cell-rich fluid
C. Clear, pale yellow fluid
D. Purulent fluid

Answer 7

C. Clear, pale yellow fluid

Rationale: A transudative pleural effusion typically consists of protein-poor, cell-poor fluid, which is usually clear and pale yellow.

Question 8

Which of the following conditions is most commonly associated with the development of a transudative pleural effusion?

A. Pneumonia
B. Heart failure
C. Lung cancer
D. Tuberculosis

Answer 8

B. Heart failure

Rationale: Transudative pleural effusions often occur in non-inflammatory conditions, such as heart failure, where there is increased hydrostatic pressure that promotes fluid accumulation.

Question 9

A patient has a transudative pleural effusion caused by hypoalbuminemia. Which condition is most likely to be the underlying cause of the effusion?

A. Chronic liver disease
B. Pneumonia
C. Lung abscess
D. Malignant tumor

Answer 9

A. Chronic liver disease

Rationale: Hypoalbuminemia, which causes decreased oncotic pressure, is commonly associated with conditions like chronic liver disease or renal disease, leading to transudative pleural effusion.

Question 10

Which of the following is characteristic of an exudative pleural effusion?

A. Protein-poor fluid
B. Clear, pale yellow fluid
C. Associated with heart failure
D. Rich in protein

Answer 10

D. Rich in protein

Rationale: Exudative pleural effusions are characterized by fluid that is rich in protein and typically occurs due to an inflammatory response, often caused by infections or cancer.

Question 11

A nurse is caring for a patient with a malignant pleural effusion. The nurse understands that this condition is most often associated with which of the following?

A. Heart failure
B. Cancer
C. Hypoalbuminemia
D. Pulmonary edema

Answer 11

B. Cancer

Rationale: Malignant pleural effusions are most commonly associated with cancer, which causes an inflammatory response and increased capillary permeability.

Question 12

Which of the following conditions is a common cause of empyema?

A. Tuberculosis
B. Heart failure
C. Pneumonia
D. Chronic liver disease

Answer 12

C. Pneumonia

Rationale: Empyema, a collection of purulent fluid in the pleural space, is commonly caused by infections such as pneumonia, tuberculosis, lung abscesses, or infected chest wounds.

Question 13

A nurse is educating a patient with a pleural effusion about the difference between transudative and exudative types. Which statement should the nurse include in the teaching?

A. “Transudative effusions are typically associated with infections, while exudative effusions occur due to conditions like heart failure.”

B. “Exudative effusions have high protein content, while transudative effusions have low protein content.”

C. “Transudative effusions occur due to inflammation, while exudative effusions are caused by a reduction in hydrostatic pressure.”

D. “Exudative effusions are generally clear and pale yellow, while transudative effusions are purulent.”

Answer 13

B. “Exudative effusions have high protein content, while transudative effusions have low protein content.”

Rationale: Exudative effusions are caused by inflammatory reactions and are rich in protein, whereas transudative effusions are protein-poor and typically occur in non-inflammatory conditions like heart failure or hypoalbuminemia.

Question 14

A patient diagnosed with an empyema is receiving treatment. The nurse should monitor the patient closely for which of the following complications?

A. Pneumothorax
B. Cardiac tamponade
C. Septicemia
D. Pulmonary embolism

Answer 14

C. Septicemia

Rationale: Empyema, which involves purulent fluid accumulation in the pleural space, can lead to infections such as septicemia, especially when caused by pneumonia, tuberculosis, or lung abscesses.

Question 15

A patient with a pleural effusion reports experiencing sharp, non-radiating chest pain that worsens with inhalation. Which of the following is the most likely cause of this symptom?

A. Pleural effusion
B. Pulmonary embolism
C. Pneumonia
D. Myocardial infarction

Answer 15

A. Pleural effusion

Rationale: Sharp, non-radiating chest pain that worsens with inhalation is a common symptom of pleural effusion, due to irritation of the pleural membranes.

Question 16

A nurse is assessing a patient with pleural effusion. Which of the following findings would be expected during the assessment?

A. Decreased breath sounds over the affected area
B. Increased lung sounds over the affected area
C. Wheezing over the affected area
D. Increased chest expansion on the affected side

Answer 16

A. Decreased breath sounds over the affected area

Rationale: Decreased breath sounds over the affected area are a common finding in pleural effusion due to the accumulation of fluid in the pleural space, which prevents proper lung expansion.

Question 17

A patient with pleural effusion is scheduled for a chest x-ray. What information will this diagnostic test provide?

A. The size and location of the pleural effusion

B. The exact protein content of the effusion fluid

C. The degree of inflammation in the pleura

D. The underlying cause of the pleural effusion

Answer 17

A. The size and location of the pleural effusion

Rationale: A chest x-ray helps determine the volume and location of the pleural effusion, although it does not provide detailed information about the protein content or underlying cause.

Question 18

A patient with empyema reports fever, night sweats, and weight loss. What is the nurse’s priority action?

A. Administer antipyretics
B. Perform a thorough lung assessment
C. Start a broad-spectrum antibiotic
D. Prepare the patient for chest tube insertion

Answer 18

C. Start a broad-spectrum antibiotic

Rationale: Empyema is a purulent infection, often caused by pneumonia or other infections. Starting a broad-spectrum antibiotic is a priority to address the infection before more specific cultures are obtained.

Question 19

A nurse is educating a patient about the clinical manifestations of pleural effusion. Which symptom should the nurse inform the patient is most commonly associated with pleural effusion?

A. Sudden onset of pleuritic chest pain
B. Persistent dry cough and weight loss
C. Severe wheezing and stridor
D. Dyspnea and cough

Answer 19

D. Dyspnea and cough

Rationale: The most common clinical manifestations of pleural effusion include dyspnea (difficulty breathing) and cough due to the accumulation of fluid in the pleural space, which impairs lung function.

Question 20

A nurse is preparing a patient for thoracentesis. Which of the following interventions should the nurse include in the plan of care?

A. Administer an intravenous antibiotic 30 minutes before the procedure

B. Instruct the patient to lie flat on their back during the procedure

C. Ensure the patient is in an upright position to avoid aspiration

D. Place the patient in a prone position to facilitate fluid drainage

Answer 20

C. Ensure the patient is in an upright position to avoid aspiration

Rationale: During thoracentesis, the patient should be positioned upright to prevent aspiration and allow easy access to the pleural space for fluid removal.

Question 21

After a chest tube insertion for pleural effusion, a nurse should monitor the patient for which of the following complications?

A. Atelectasis
B. Pneumothorax
C. Pleural fibrosis
D. Pulmonary embolism

Answer 21

B. Pneumothorax

Rationale: Pneumothorax is a potential complication of chest tube insertion, as the procedure can inadvertently puncture the lung, causing air to enter the pleural space.

Question 22

A patient undergoing chest physiotherapy for a pleural effusion asks why it is necessary. The nurse explains that chest physiotherapy is used to:

A. Increase lung compliance and improve ventilation

B. Remove purulent fluid from the pleural space

C. Prevent infection in the pleura

D. Stimulate coughing to help remove fluid

Answer 22

A. Increase lung compliance and improve ventilation

Rationale: Chest physiotherapy helps improve ventilation and lung compliance by mobilizing secretions, which can enhance gas exchange and relieve symptoms in patients with pleural effusion.

Question 23

A nurse is caring for a patient with a pleural effusion who is receiving oxygen therapy. The nurse’s priority goal is to:

A. Relieve chest pain
B. Improve oxygenation and treat hypoxemia
C. Prevent re-accumulation of pleural fluid
D. Promote proper hydration and nutrition

Answer 23

B. Improve oxygenation and treat hypoxemia

Rationale: Oxygen therapy is provided to treat hypoxemia, which is a common manifestation of pleural effusion due to impaired lung expansion and gas exchange.

Question 24

A patient with empyema is being treated with percutaneous drainage. The nurse understands that this treatment is primarily intended to:

A. Remove the infected fluid from the pleural space
B. Instill a chemical slurry to prevent fluid re-accumulation
C. Administer oxygen therapy to improve hypoxemia
D. Provide pain relief by draining the pleura

Answer 24

A. Remove the infected fluid from the pleural space

Rationale: Percutaneous drainage is used to remove infected fluid in patients with empyema, aiding in the management of the infection and symptoms.

Question 25

After undergoing chemical pleurodesis, a patient complains of fever and chest pain. The nurse recognizes that these are: A. Complications of chest tube insertion B. Symptoms of an allergic reaction to the chemical agent C. Signs of a pneumothorax D. Common side effects after pleurodesis

Answer 25

D. Common side effects after pleurodesis Rationale: Fever and chest pain are common side effects after pleurodesis due to inflammation and irritation of the pleura from the chemical agent used in the procedure.

Question 26

A nurse is caring for a patient who is undergoing chemical pleurodesis. The patient asks what the procedure will involve. The nurse should explain that the procedure involves: A. Surgical removal of the pleural space B. Insertion of a chest tube to drain fluid followed by the instillation of a chemical agent into the pleural space C. Repeated thoracentesis to remove fluid D. Use of antibiotics to treat infection in the pleural space

Answer 26

B. Insertion of a chest tube to drain fluid followed by the instillation of a chemical agent into the pleural space Rationale: Chemical pleurodesis involves draining the pleural effusion with a chest tube, followed by the instillation of a chemical agent (such as talc) to obliterate the pleural space and prevent fluid re-accumulation.

Question 27

A patient with a malignant pleural effusion is undergoing thoracentesis for symptom relief. The nurse should be aware that this type of effusion is most likely to: A. Re-accumulate rapidly after the procedure B. Resolve completely with one thoracentesis C. Be easily managed with antibiotics D. Respond well to diuretics

Answer 27

A. Re-accumulate rapidly after the procedure Rationale: Malignant pleural effusions often re-accumulate quickly after thoracentesis due to the underlying cancer, making their management more challenging.

Question 28

A patient with heart failure (HF) is diagnosed with a pleural effusion. Which of the following treatments would be most appropriate to manage the effusion in this patient? A. Antibiotic therapy B. Chest tube insertion C. Diuretics and sodium restriction D. Percutaneous drainage

Answer 28

C. Diuretics and sodium restriction Rationale: In patients with heart failure, pleural effusions can be managed by treating the underlying cause. Diuretics and sodium restriction help reduce fluid accumulation by addressing the heart failure.

Question 29

A patient is diagnosed with empyema. Which clinical manifestation should the nurse expect during assessment? a. Hemoptysis and barrel chest b. Dullness on percussion and diminished breath sounds c. Stridor and wheezing d. Hyperresonance on percussion and decreased fremitus

Answer 29

b. Dullness on percussion and diminished breath sounds Rationale: Empyema, which is pus accumulation in the pleural space, typically presents with signs of fluid collection, such as dullness on percussion and diminished or absent breath sounds over the affected area. Hemoptysis, stridor, wheezing, and hyperresonance are not characteristic findings of empyema.

Question 30

What is the primary goal of treatment for a patient with empyema? a. Reduce fever and prevent pleural effusion recurrence b. Drain the infected pleural fluid and promote lung re-expansion c. Relieve dyspnea with supplemental oxygen therapy d. Administer antibiotics to prevent systemic infection

Answer 30

b. Drain the infected pleural fluid and promote lung re-expansion Rationale: The primary treatment goal for empyema is to remove the infected pleural fluid through drainage, such as with thoracentesis or chest tube placement, and promote lung re-expansion to restore respiratory function. Although antibiotics are critical for treating the infection, fluid drainage is necessary to resolve the empyema.

Question 31

A patient with empyema is scheduled for thoracentesis. What clinical finding would indicate a successful outcome of this procedure? a. Decreased chest pain and improved breath sounds b. Increased respiratory rate and work of breathing c. Decreased fever and reduced WBC count d. Improved oxygen saturation and capillary refill

Answer 31

a. Decreased chest pain and improved breath sounds Rationale: Thoracentesis, which removes pleural fluid, alleviates symptoms such as chest pain and breathlessness while improving lung re-expansion, often indicated by better breath sounds. Fever and WBC count may improve with infection resolution, but these are secondary outcomes.

Question 32

A patient with empyema reports sharp chest pain that worsens with deep breathing. What is the priority nursing intervention? a. Administer prescribed opioid analgesic b. Encourage the patient to perform incentive spirometry c. Notify the healthcare provider immediately d. Position the patient in semi-Fowler's

Answer 32

d. Position the patient in semi-Fowler's Rationale: Pain relief is important, but non-invasive measures should be attempted first. Incentive spirometry may exacerbate pain initially, and notifying the provider is unnecessary unless there are signs of deterioration.

Question 33

Which laboratory or diagnostic test result is most indicative of empyema? a. Positive blood cultures b. Elevated D-dimer levels c. Pleural fluid analysis revealing purulent exudate d. Increased lactate dehydrogenase (LDH) in serum

Answer 33

c. Pleural fluid analysis revealing purulent exudate Rationale: A definitive diagnosis of empyema is based on pleural fluid analysis that shows purulent exudate, which confirms infection. While positive blood cultures may indicate sepsis, they are not specific to empyema. LDH levels may be elevated but are not diagnostic.

Question 34

A patient is undergoing chest tube placement for empyema. What finding in the drainage system would the nurse report to the healthcare provider immediately? a. Intermittent bubbling in the water seal chamber b. A sudden increase in the amount of drainage to 500 mL in one hour c. Gradual decrease in pleural fluid drainage over 24 hours d. Continuous fluid movement in the tubing during inspiration and expiration

Answer 34

b. A sudden increase in the amount of drainage to 500 mL in one hour Rationale: A sudden and excessive increase in pleural fluid drainage may indicate hemorrhage or other complications and must be reported immediately. Intermittent bubbling, gradual decreases in drainage, and fluid movement in the tubing are expected findings.

Question 35

Which patient statement indicates that the treatment goals for empyema are being met? a. "I can take deep breaths without any sharp pain." b. "I am coughing up large amounts of thick yellow sputum." c. "I still feel short of breath even after my thoracentesis." d. "My temperature is still 101°F, but I feel fine otherwise."

Answer 35

a. "I can take deep breaths without any sharp pain." Rationale: The resolution of chest pain and improvement in breathing signify treatment effectiveness in empyema, as these indicate lung re-expansion and infection control. Persistent fever or dyspnea suggests incomplete treatment.

Question 36

The patient with a right-side pleural effusion has stable vital signs and O2 at 6 L/min via nasal cannula. A right-side chest tube is attached to straight drainage. Which actions would the nurse include in the plan of care? (select all that apply) a. Placing the patient on NPO status b. Administering analgesia as ordered c. Maintaining high-Fowler’s position d. Encouraging deep breathing and coughing e. Monitoring color and amount of chest tube drainage

Answer 36

b. Administering analgesia as ordered c. Maintaining high-Fowler’s position d. Encouraging deep breathing and coughing e. Monitoring color and amount of chest tube drainage