Pneumothorax Hemothorax NCLEX Practice Questions

Pneumothorax & Hemothorax (NCLEX) Practice Questions

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25 terms klh2774Preview ARDS n 33 terms alm A patient was admitted after a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax, which includes which of the following?

A: Sharp pleuritic pain that worsens on inspiration

B: Crackles over lung bases of affected lung

C: Tracheal deviation toward the affected lung

D: Increased diaphragmatic excursion on side of rib

fractures A A patient was admitted following a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax. Which are the most common assessment findings associated with a pneumothorax? (Select all that apply).

• Sharp pleuritic pain that worsens on inspiration
• Crackles over lung bases of affected lung
• Tracheal deviation toward the affected lung
• Worsening dyspnea
• Absent lung sounds to auscultation on affected side

ADE

The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client?

• A low respiratory rate
• Diminished breath sounds
• The presence of a barrel chest
• A sucking sound at the site of injury

B A patient is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube?

• To remove air from the pleural space
• To drain copious sputum secretions
• To monitor bleeding around the lungs
• To assist with mechanical ventilation

A The nurse is caring for a patient after thoracentesis. Which actions can be delegated from the nurse to the unlicensed assistive personnel (UAP)? Select all that apply.

1.) Assess puncture site and dressing for leakage.

2.)Check vital signs every 15 minutes for 1 hour.

3.) Auscultate for absent or reduced lung sounds.

4.)Remind the patient to take deep breaths.

5.)Take the specimens to the laboratory.

6.) Teach the patient symptoms of pneumothorax.245 A patient enters the ED presenting with symptoms of shortness of breath, severe chest pain, and diminished heart sounds. His blood pressure is 90/70 and his heart rate is 110. You notice that the trachea appears to be deviated to the right. What is your nursing priority?

• Prepare for an emergency insertion of a needle into

the second intercostal space, midclavicular line

• Hang IV fluids and prepare for chest tube insertion
• Encourage patient to breathe into a paper bag and

obtain ABG's.

• Assess for allergies and administer epinephrine as

ordered A This patient is presenting with symptoms of a tension pneumothorax. In this emergent situation, a needle can be inserted at the second intercostal space, midclavicular line to immediately allow some air to flow out of the pleural space. A chest tube would then be inserted. The lung re-expansion would correct the abnormal blood pressure and heart rate, and the patient does not appear to be having an allergic reaction.

The patient has been diagnosed with having an open pneumothorax r/t penetrating injury. Which of the following symptoms would the nurse most expect to see in this patient?

• Chest pain and tracheal shifting
• Hyperresanance and hyperexpansion of the affected

side

• High pitched respiratory sounds and SpO2 89%
• Muffled heart sounds and bradycardia

C An open pneumothorax is often also known as a sucking chest wound, producing a high pitched sucking sound coming from the wound. Diminished oxygen level, hyperresanance, and chest pain would also be expected in this patient. Tracheal shifting and hyperexpansion of the lung may be seen in a tension pneumothorax (an unlikely development of an open pneumothorax). Tachycardia, rather than bradycardia would be a common symptom in pneumothorax.The nurse is taking care of the patient with a pneumothorax. Which of the following, if found in the patients history, would be most contributory to the development of this pneumothorax?

• MVA involvement approximately 2 weeks ago.
• Hx of diabetes, HTN, and asthma
• Insertion of subclavian line yesterday
• Daily use of albuterol and corticosteroid inhaler

C Insertion of a subclavian line is often associated with traumatic pneumothorax.Some other procedures that may also cause this condition include throracentesis, endotracheal intubation, or transbronchial lung biopsy A nurse enters the room of a patient with a left-sided pneumothorax to perform an afternoon assessment. The nurse finds the patient's trachea deviated slightly to the right side compared to her morning findings, and the patient reports feeling increasingly short of breath. What is the first action the nurse should take?1) Administer high-flow supplemental oxygen.2) Position the patient's HOB at 30-45 degrees.3) Call the physician.4) Document the extent of tracheal shift in the patient's chart and reassess in 15 minutes.1 High-flow supplemental oxygen should be administered immediately to offset the unavoidable result of hypoxemia. The nurse should also ensure a POX is applied.Adjusting the HOB will not adequately relieve the patient's shortness of breath.The nurse should include all of the following in the plan of care for the client with a chest tube r/t hemothorax?

SATA:

• Report drainage of 100 ml/hr
• Teach the patient to cough and deep breath frequently
• Report intermittent bubbling in the water seal

chamber

• Keep the patient on bedrest with bedside commode
• Loop tubing to keep it off of the floor

ABC Your patient with chronic obstructive pulmonary disease suddenly complains of sharp pain that began with a coughing fit. You know the doctor will require the

following:

a) Surgical consent for lobectomy

b) Nothing- this is normal

c) Chest tube set-up

d) Ventilator set-up

C Patients with COPD and certain other chronic lung conditions are at a high risk for spontaneous pneumothorax. A chest tube would be needed to treat this condition.

A patient has come into the ED with a hemothorax and has had a chest tube inserted 2 hours ago. Which of the following would be most concerning if observed by the nurse?

• Tidaling in the water seal of the chest tube with a

popping sensation in the skin around the chest tube

• The patient is complaining of pain 8/10 and is taking

shallow breaths with a RR of 27

• There is intermittent bubbling in the water seal of the

chest tube with 200 ml of bright red drainage

• The patient begins to pick at his IV lines and tries to

get out of bed and is sweating profusely D Restlessness and Diaphoresis symptoms of hypoxemia and possible development of ARF. This requires immediate intervention. Tidaling in the water seal portion of the chest tube and subcutaneous emphysema are normal/benign findings and should be documented. Severe pain and elevated RR would be expected in this patient, but should be monitored for worsening severity. While 200 ml of bright red drainage would be expected after immediate insertion of the chest tube, intermittent bubbling would NOT be expected in the case of hemothorax. This indicates and air leak and should be investigated, but is not the most concerning in this situation.A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client's vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following?

• Spontaneous pneumothorax
• Ruptured diaphragm
• Hemothorax
• Pericardial tamponade

D The reading of CVP of 20 means that there increased venous pressure backing up because the heart is not pumping effective. This would indicate the presence of cardiac tamponade.A nurse walks in to a client who is in respiratory distress.The client has tracheal deviation to the right side. The nurse knows to prepare for which of the following emergent procedures?

• Chest tube insertion on the left side.
• Chest tube insertion on the right side.
• Intubation
• Tracheostomy

A A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia.The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?

• Closed pneumothorax
• Open pneumothorax
• Tension pneumothorax
• Spontaneous pneumothorax

B This description is of an open pneumothorax. An open pneumothorax happens when there is an opening in the chest wall ( from a gun shot, stabbing etc.) that creates a passage between the outside air and intrapleural space. This allow air to pass back and forth during inspiration and expiration. The body will shunt air through the opening in the chest well instead of the trachea (if the opening on the chest is large enough) which will create a "sucking" sound.