MIDTERM Flashcards
Question: A patient’s ABG results are pH 7.48, PaCO₂ 30 mmHg, and HCO₃ 22 mEq/L. How should the nurse interpret this?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A. Respiratory alkalosis
Rationale: A high pH (alkalosis) and a low PaCO₂ indicate respiratory alkalosis caused by hyperventilation.
Question: Which condition commonly causes metabolic acidosis?
A. Vomiting
B. Chronic kidney disease
C. Hyperventilation
D. Narcotic overdose
Answer: B. Chronic kidney disease
Rationale: Chronic kidney disease leads to the accumulation of acids due to impaired excretion, causing metabolic acidosis.
Question: A patient with respiratory acidosis will likely exhibit:
A. Kussmaul respirations
B. Bradypnea
C. Hyperventilation
D. Metabolic alkalosis
Answer: B. Bradypnea
Rationale: Respiratory acidosis occurs due to hypoventilation, which results in CO₂ retention.
Question: A patient with prolonged vomiting is at risk for which acid-base imbalance?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: B. Metabolic alkalosis
Rationale: Loss of gastric acid through vomiting increases the pH, causing metabolic alkalosis.
Question: How does the body compensate for metabolic acidosis?
A. Retaining CO₂
B. Hyperventilation
C. Retaining HCO₃
D. Decreasing renal acid excretion
Answer: B. Hyperventilation
Rationale: The body increases respiratory rate to “blow off” CO₂ and lower acid levels.
Question: What is the normal pH range of arterial blood?
A. 7.30 to 7.35
B. 7.35 to 7.45
C. 7.40 to 7.50
D. 7.45 to 7.55
Answer: B. 7.35 to 7.45
Rationale: Normal blood pH ranges between 7.35 and 7.45.
What is the normal PaCO2 range of arterial blood?
35-45
What is the normal HCO3 range of arterial blood?
22-26
Which item must always be at the bedside of a patient with a chest tube?
A. Sterile water
B. Pulse oximeter
C. Ambu bag
D. Clamp
Answer: A. Sterile water
Rationale: Sterile water is used to submerge the tube if it becomes disconnected, preventing air entry.
Question: Which chamber of a chest tube system should have continuous bubbling in the presence of an air leak?
A. Collection chamber
B. Suction control chamber
C. Water seal chamber
D. Drainage chamber
Answer: C. Water seal chamber
Rationale: Bubbling in the water seal chamber indicates an air leak in the system.
Question: What complication should the nurse monitor for in a patient with a chest tube?
A. Subcutaneous emphysema
B. Hypervolemia
C. Pneumonia
D. Hypertension
Answer: A. Subcutaneous emphysema
Rationale: Air can leak into subcutaneous tissue, causing swelling and crackling under the skin.
Question: What is the nurse’s immediate action if a chest tube is accidentally dislodged?
A. Cover the site with an occlusive dressing taped on three sides.
B. Reinsert the chest tube immediately.
C. Notify the healthcare provider.
D. Clamp the tube at the insertion site.
Answer: A. Cover the site with an occlusive dressing taped on three sides.
Rationale: This prevents air from re-entering the pleural space while allowing air to escape.
Question: The nurse observes no tidaling in the water seal chamber. What does this indicate?
A. The lung has re-expanded.
B. There is an air leak.
C. The suction is too high.
D. The tubing is obstructed.
Answer: A. The lung has re-expanded.
Rationale: Tidaling stops when the pleural space is no longer under negative pressure.
Question: If a chest tube becomes disconnected from the drainage system, the nurse should:
A. Clamp the chest tube immediately
B. Immerse the tube in sterile water
C. Remove the chest tube
D. Reinforce the dressing
Answer: B. Immerse the tube in sterile water
Rationale: Placing the tube in sterile water maintains the water seal and prevents air entry.
Question: What is a sign of a tension pneumothorax in a patient with a chest tube?
A. Tracheal deviation
B. Subcutaneous emphysema
C. Diminished breath sounds bilaterally
D. Mild respiratory distress
Answer: A. Tracheal deviation
Rationale: Tracheal deviation is a late sign of a tension pneumothorax and requires immediate intervention.
Question: How should a patient be positioned for a thoracentesis?
A. Supine with arms at the sides
B. Sitting upright, leaning forward
C. Lateral recumbent position
D. Trendelenburg position
Answer: B. Sitting upright, leaning forward
Rationale: This position allows better access to the pleural space and facilitates drainage.
Question: The nurse should monitor the patient post-thoracentesis for which complication?
A. Pneumothorax
B. Pleural effusion
C. Increased urine output
D. Hypercapnia
Answer: A. Pneumothorax
Rationale: Accidental lung puncture can result in a pneumothorax, which requires immediate assessment.
Question: What is the nurse’s priority post-thoracentesis?
A. Assess for hypotension
B. Check for bleeding
C. Monitor respiratory status
D. Check bowel sounds
Answer: C. Monitor respiratory status
Rationale: Changes in respiratory rate or breath sounds may indicate pneumothorax or reaccumulation of fluid.
Question: What is the primary purpose of a thoracentesis?
A. To collect pleural fluid for analysis
B. To obtain lung tissue biopsy
C. To drain fluid from the abdomen
D. To check for rib fractures
Answer: A. To collect pleural fluid for analysis
Rationale: Thoracentesis is performed to drain and analyze pleural fluid for diagnostic or therapeutic purposes.
Question: Which is a potential post-procedure concern for thoracentesis?
A. Hyperventilation
B. Pulmonary edema
C. Pneumothorax
D. Bronchospasm
Answer: C. Pneumothorax
Rationale: Lung puncture during the procedure may lead to a pneumothorax.
Question: The nurse notes that 1,500 mL of pleural fluid has been removed during a thoracentesis. What is the concern?
A. Fluid overload
B. Re-expansion pulmonary edema
C. Hemorrhage
D. Increased oxygenation
Answer: B. Re-expansion pulmonary edema
Rationale: Removing large amounts of pleural fluid can cause re-expansion pulmonary edema.
Question: After thoracentesis, the nurse instructs the patient to:
A. Lie on the affected side
B. Avoid deep breathing
C. Report sudden chest pain or difficulty breathing
D. Increase oral fluid intake
Answer: C. Report sudden chest pain or difficulty breathing
Rationale: Chest pain or difficulty breathing may indicate pneumothorax or complications.
Question: A patient’s ABG shows pH 7.32, PaCO₂ 50 mmHg, and HCO₃ 28 mEq/L. What does this indicate?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is low (acidosis), and the PaCO₂ is elevated, indicating respiratory acidosis. The HCO₃ is slightly elevated, showing partial compensation by the kidneys.
Question: A patient with a chest tube drainage system has an output of 150 mL of bright red blood in one hour. What is the nurse’s priority action?
A. Document the findings as normal.
B. Notify the healthcare provider immediately.
C. Clamp the chest tube.
D. Reinforce the dressing.
Answer: B. Notify the healthcare provider immediately.
Rationale: Bright red drainage over 100 mL/hour may indicate hemorrhage and requires immediate provider notification.
Question: During post-procedure assessment after thoracentesis, the patient reports sudden sharp chest pain and shortness of breath. What should the nurse do first?
A. Administer oxygen
B. Auscultate lung sounds
C. Notify the healthcare provider
D. Place the patient in a supine position
Answer: B. Auscultate lung sounds
Rationale: The nurse should assess for decreased or absent breath sounds, which may indicate a pneumothorax, a common complication.
Question: A patient has a pH of 7.28 and PaCO₂ of 56 mmHg. What is the most likely cause?
A. Diabetic ketoacidosis
B. COPD exacerbation
C. Prolonged vomiting
D. Hyperventilation
Answer: B. COPD exacerbation
Rationale: Respiratory acidosis (low pH and high PaCO₂) occurs due to CO₂ retention from hypoventilation, often seen in COPD exacerbations.
Question: A nurse finds the chest tube dislodged on the floor. What is the immediate action?
A. Place a sterile occlusive dressing on the insertion site.
B. Reconnect the tubing and secure it.
C. Call for an X-ray to assess lung status.
D. Clamp the chest tube.
Answer: A. Place a sterile occlusive dressing on the insertion site.
Rationale: Covering the insertion site prevents air from entering the pleural space, reducing the risk of tension pneumothorax.
Question: The nurse is explaining the blood flow through the heart. Which is the correct order of blood flow, starting with the vena cavae?
A. Vena cavae → Right atrium → Tricuspid valve → Right ventricle → Pulmonic valve → Pulmonary artery → Lungs → Pulmonary veins → Left atrium → Mitral valve → Left ventricle → Aortic valve → Aorta
B. Vena cavae → Left atrium → Tricuspid valve → Left ventricle → Pulmonic valve → Pulmonary artery → Lungs → Pulmonary veins → Right atrium → Mitral valve → Right ventricle → Aortic valve → Aorta
C. Vena cavae → Right ventricle → Tricuspid valve → Right atrium → Pulmonic valve → Pulmonary artery → Lungs → Pulmonary veins → Left ventricle → Mitral valve → Left atrium → Aortic valve → Aorta
Answer: A
Rationale: Blood flows into the right atrium via the vena cavae, through the tricuspid valve into the right ventricle, then to the lungs via the pulmonary artery. Oxygenated blood returns to the left atrium via the pulmonary veins, flows through the mitral valve into the left ventricle, and exits through the aorta.
Question: A nurse is teaching a patient about the cardiac electrical conduction system. Which structure initiates the electrical impulse?
A. AV node
B. Purkinje fibers
C. SA node
D. Bundle of His
Answer: C. SA node
Rationale: The sinoatrial (SA) node is the pacemaker of the heart, initiating electrical impulses that trigger cardiac contraction.
Question: On an ECG, the QRS complex represents:
A. Atrial depolarization
B. Ventricular depolarization
C. Ventricular repolarization
D. Atrial repolarization
Answer: B. Ventricular depolarization
Rationale: The QRS complex corresponds to the depolarization of the ventricles, leading to ventricular contraction.
Question: What differentiates unstable angina from stable angina?
A. Pain occurs only during activity.
B. Pain is relieved by rest or nitroglycerin.
C. Pain occurs at rest and is unpredictable.
D. Pain lasts less than 5 minutes.
Answer: C. Pain occurs at rest and is unpredictable.
Rationale: Unstable angina involves pain that occurs at rest, lasts longer, and is less responsive to nitroglycerin.
Question: Which laboratory test is most indicative of heart failure?
A. D-dimer
B. Troponin
C. BNP
D. CK-MB
Answer: C. BNP
Rationale: B-type natriuretic peptide (BNP) increases when the ventricles are stretched, indicating heart failure.
Question: What is the major diagnostic criterion for infective endocarditis?
A. Elevated white blood cell count
B. Positive blood cultures
C. Chest pain
D. Enlarged heart on X-ray
Answer: B. Positive blood cultures
Rationale: Positive blood cultures are a major criterion for diagnosing infective endocarditis as they confirm the presence of bacteria in the bloodstream.
Question: Which test is the gold standard for diagnosing myocarditis?
A. Echocardiogram
B. Chest X-ray
C. Cardiac biopsy
D. ECG
Answer: C. Cardiac biopsy
Rationale: A cardiac biopsy provides definitive diagnosis by identifying inflammatory changes in myocardial tissue.
Question: What is a common ECG finding in a patient with pericarditis?
A. ST elevation in all leads
B. Q waves
C. ST depression
D. Peaked T waves
Answer: A. ST elevation in all leads
Rationale: Pericarditis typically presents with diffuse ST elevation across all leads due to inflammation of the pericardium.
Question: Which is a common clinical manifestation of pleural effusion?
A. Dry cough
B. Abdominal distention
C. Crackles in both lungs
D. Chest pain that worsens on inspiration
Answer: D. Chest pain that worsens on inspiration
Rationale: Pleural effusion causes pleuritic chest pain, particularly during deep breathing.
What does an ECG look for pt with stable agina?
ST Segment Depression
Question: What is the primary goal of treatment for empyema?
A. Decrease pain
B. Drain the infected pleural fluid
C. Administer antiviral medications
D. Prevent fluid accumulation
Answer: B. Drain the infected pleural fluid
Rationale: The main goal is to remove infected pleural fluid through chest tube placement or surgical intervention.
Question: What differentiates a tension pneumothorax from a spontaneous pneumothorax?
A. Tension pneumothorax occurs without warning.
B. Tension pneumothorax causes mediastinal shift.
C. Spontaneous pneumothorax is caused by trauma.
D. Spontaneous pneumothorax is life-threatening.
Answer: B. Tension pneumothorax causes mediastinal shift.
Rationale: In a tension pneumothorax, air accumulates and shifts mediastinal structures, compromising cardiac function.
Question: Which is the priority nursing intervention for pulmonary edema?
A. Administer diuretics
B. Place the patient in supine position
C. Encourage deep breathing exercises
D. Restrict oral fluids
Answer: A. Administer diuretics
Rationale: Diuretics such as furosemide reduce fluid overload, which is critical in treating pulmonary edema.
Question: Which diagnostic test is most definitive for diagnosing a pulmonary embolism?
A. D-dimer
B. Chest X-ray
C. CT pulmonary angiography
D. Ventilation-perfusion scan
Answer: C. CT pulmonary angiography
Rationale: CT pulmonary angiography is the gold standard for visualizing emboli in the pulmonary arteries.
Question: A patient’s ABG shows pH 7.30, CO₂ 50 mmHg, and HCO₃ 24 mEq/L. How should the nurse interpret this?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A. Respiratory acidosis
Rationale: A low pH and elevated CO₂ indicate respiratory acidosis caused by hypoventilation.
Question: What is the nurse’s priority action if a chest tube becomes disconnected?
A. Clamp the tube immediately
B. Reinsert the tube
C. Place the tube in sterile water
D. Notify the provider immediately
Answer: C. Place the tube in sterile water
Rationale: Placing the tube in sterile water prevents air from entering the pleural space, reducing the risk of a pneumothorax.
Question: After a thoracentesis, the nurse should monitor the patient for:
A. Fever
B. Hypertension
C. Pneumothorax
D. Fluid overload
Answer: C. Pneumothorax
Rationale: Pneumothorax is a potential complication due to accidental puncture of the lung during the procedure.
Question: Which medication improves heart failure symptoms by reducing fluid overload?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Metoprolol
Answer: B. Furosemide
Rationale: Furosemide is a diuretic that reduces fluid retention, improving symptoms of heart failure.
Question: Which organism is most commonly responsible for infective endocarditis?
A. Escherichia coli
B. Streptococcus viridans
C. Pseudomonas aeruginosa
D. Candida albicans
Answer: B. Streptococcus aureus (viridans)
Rationale: Streptococcus viridans is the most common causative agent in infective endocarditis, especially in dental procedures.
Question: What is the priority treatment for a patient experiencing acute chest pain?
A. Administer morphine
B. Provide supplemental oxygen
C. Perform an ECG
D. Give sublingual nitroglycerin
Answer: D. Give sublingual nitroglycerin
Rationale: Nitroglycerin is the first-line treatment to relieve acute chest pain caused by myocardial ischemia.
Question: Which is a common cause of myocarditis?
A. Fungal infection
B. Viral infection
C. Bacterial infection
D. Autoimmune reaction
Answer: B. Viral infection
Rationale: Viral infections, such as Coxsackievirus, are the most common causes of myocarditis.
Question: Which diagnostic test confirms the presence of a pleural effusion?
A. MRI
B. Bronchoscopy
C. CT
D. Arterial blood gas
Answer: C. CT
Rationale: A chest X-ray can detect fluid accumulation in the pleural space.
Question: Which symptom is characteristic of pericarditis?
A. Pain that improves when leaning forward
B. Pain that radiates to the jaw
C. Persistent dry cough
D. Shortness of breath with exertion
Answer: A. Pain that improves when leaning forward
Rationale: Leaning forward reduces pressure on the inflamed pericardium, alleviating pain.
Question: Which lung sound is most commonly associated with pulmonary edema?
A. Wheezing
B. Crackles
C. Pleural rub
D. Diminished breath sounds
Answer: B. Crackles
Rationale: Crackles result from fluid accumulation in the alveoli, a hallmark of pulmonary edema.
Question: What is a common characteristic of chronic stable angina?
A. Pain occurs unpredictably at rest.
B. Pain is relieved by rest or nitroglycerin.
C. Pain persists despite medication.
D. Pain lasts longer than 20 minutes.
Answer: B. Pain is relieved by rest or nitroglycerin.
Rationale: Chronic stable angina is predictable and relieved by rest or nitroglycerin.
Question: A patient has a pH of 7.28 and PaCO₂ of 56 mmHg. What is the most likely cause?
A. Diabetic ketoacidosis
B. COPD exacerbation
C. Prolonged vomiting
D. Hyperventilation
Answer: B. COPD exacerbation
Rationale: Respiratory acidosis (low pH and high PaCO₂) occurs due to CO₂ retention from hypoventilation, often seen in COPD exacerbations.
Question: A nurse finds the chest tube dislodged on the floor. What is the immediate action?
A. Place a sterile occlusive dressing on the insertion site.
B. Reconnect the tubing and secure it.
C. Call for an X-ray to assess lung status.
D. Clamp the chest tube.
Answer: A. Place a sterile occlusive dressing on the insertion site.
Rationale: Covering the insertion site prevents air from entering the pleural space, reducing the risk of tension pneumothorax.
Question: A patient’s ABG shows pH 7.32, PaCO₂ 50 mmHg, and HCO₃ 28 mEq/L. What does this indicate?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is low (acidosis), and the PaCO₂ is elevated, indicating respiratory acidosis. The HCO₃ is slightly elevated, showing partial compensation by the kidneys.
Question: After thoracentesis, the nurse instructs the patient to:
A. Lie on the affected side
B. Avoid deep breathing
C. Report sudden chest pain or difficulty breathing
D. Increase oral fluid intake
Answer: C. Report sudden chest pain or difficulty breathing
Rationale: Chest pain or difficulty breathing may indicate pneumothorax or complications.
Question: Which is a potential post-procedure concern for thoracentesis?
A. Hyperventilation
B. Pulmonary edema
C. Pneumothorax
D. Bronchospasm
Answer: C. Pneumothorax
Rationale: Lung puncture during the procedure may lead to a pneumothorax.
Question: What is the nurse’s priority post-thoracentesis?
A. Assess for hypotension
B. Check for bleeding
C. Monitor respiratory status
D. Check bowel sounds
Answer: C. Monitor respiratory status
Rationale: Changes in respiratory rate or breath sounds may indicate pneumothorax or reaccumulation of fluid.
Question: How should a patient be positioned for a thoracentesis?
A. Supine with arms at the sides
B. Sitting upright, leaning forward
C. Lateral recumbent position
D. Trendelenburg position
Answer: B. Sitting upright, leaning forward
Rationale: This position allows better access to the pleural space and facilitates drainage.
Question: What is a sign of a tension pneumothorax in a patient with a chest tube?
A. Tracheal deviation
B. Subcutaneous emphysema
C. Diminished breath sounds bilaterally
D. Mild respiratory distress
Answer: A. Tracheal deviation
Rationale: Tracheal deviation is a late sign of a tension pneumothorax and requires immediate intervention.
Question: The nurse observes no tidaling in the water seal chamber. What does this indicate?
A. The lung has re-expanded.
B. There is an air leak.
C. The suction is too high.
D. The tubing is obstructed.
Answer: A. The lung has re-expanded.
Rationale: Tidaling stops when the pleural space is no longer under negative pressure.
Question: If a chest tube becomes disconnected from the drainage system, the nurse should:
A. Clamp the chest tube immediately
B. Immerse the tube in sterile water
C. Remove the chest tube
D. Reinforce the dressing
Answer: B. Immerse the tube in sterile water
Rationale: Placing the tube in sterile water maintains the water seal and prevents air entry.
Question: What is the nurse’s immediate action if a chest tube is accidentally dislodged?
A. Cover the site with an occlusive dressing taped on three sides.
B. Reinsert the chest tube immediately.
C. Notify the healthcare provider.
D. Clamp the tube at the insertion site.
Answer: A. Cover the site with an occlusive dressing taped on three sides.
Rationale: This prevents air from re-entering the pleural space while allowing air to escape.
Question: Which chamber of a chest tube system should have continuous bubbling in the presence of an air leak?
A. Collection chamber
B. Suction control chamber
C. Water seal chamber
D. Drainage chamber
Answer: C. Water seal chamber
Rationale: Bubbling in the water seal chamber indicates an air leak in the system.
ABG’S Uncompensated
There is an abnormality in pH due to either respiratory or metabolic disturbance, and the opposing system has not yet started to compensate.
ABG’S Partially Compensated
The body has started to compensate for the disturbance, the opposing system has started to compensate (so it shifts to the other direction)
ABG’S Fully Compensated
The body has successfully compensated for the disturbance, and the pH has returned to normal range (7.35–7.45).
