Medical Tests Medical Tests Certifications CEN Questions & Answers

• Question 81:

  You are changing the tape on a tracheostomy tube when the patient coughs, and the tube becomes

  dislodged.

  The initial action of the nurse should be:

  A. Cover the site with a sterile dressing.

  B. Notify the physician.

  C. Grasp the retention sutures and spread the opening.

  D. Notify the respiratory therapist.

  Correct Answer: C

  The nurse should grasp the retention sutures and spread the opening of the site. If policy allows, the nurse would then reinsert the tracheostomy or notify the physician to come reinsert the tube. The nurse should be sure not to do anything that would block the airway until the tube is reinserted.

• Question 82:

  You are assisting the physician with removal of a chest tube. The nurse should instruct the patient to:

  A. Remain very still.

  B. Inhale and exhale quickly.

  C. Exhale slowly.

  D. Perform the Valsalva's maneuver.

  Correct Answer: D

  The nurse should instruct the patient to perform the Valsalva's maneuver (take a deep breathe, exhale and bear down). Then the tube would be quickly removed and an airtight dressing placed. An alternative would be to ask the patient to take a deep breathe and hold the breath while the tube is removed.

• Question 83:

  You are caring for a patient with a chest tube. When you turn the patient to the side the tube comes disconnected. What action should you take next?

  A. Notify the physician

  B. Place the tube in a bottle of sterile water

  C. Replace the chest tube

  D. Put a sterile dressing over the disconnected site

  Correct Answer: B

  The nurse should immediately place the tube in a bottle of sterile water. The system can then be replaced if necessary. A sterile dressing will not prevent complications associated with disconnection. The physician will need to be notified after the tube has been placed in sterile water.

• Question 84:

  You have assisted the physician with insertion of a chest tube. As you monitor the fluid level in the water seal chamber you notice fluctuations in the fluid. What is the appropriate action?

  A. Notify the physician.

  B. Encourage the patient to deep breathe.

  C. This is a normal finding.

  D. Reinforce the dressing.

  Correct Answer: C

  Fluctuations of the fluid in the water seal chamber is a normal finding and the nurse should do nothing at this point. The water levels will rise and fall with the patient's breathing pattern. The fluctuations will stop if the tube is obstructed, if suction is not working or if the lung is reexpanded.

• Question 85:

  You are caring for a patient with chronic obstructive pulmonary disease who has come in with respiratory distress. The patient takes theophylline (Theo-Dur). A therapeutic level is drawn on the patient. You would know the patient needs to be educated on complying with medication if the therapeutic is what?

  A. 10 mcg/mL

  B. 12 mcg/mL

  C. 15 mcg/mL

  D. 18 mcg/mL

  Correct Answer: A

  The patient will need further education on the necessity of taking medications if the theophylline level is 10 mcg/mL. The therapeutic range is 10 to 20 mcg/mL. If the level is low, the patient will experience frequent exacerbations of the disease.

• Question 86:

  You are caring for a patient who is in diabetic ketoacidosis. You observe the patient in Kussmaul

  respiration.

  What are Kussmaul respirations?

  A. Abnormally deep, regular and increased respirations

  B. Regular, slow respirations

  C. Labored, increased respirations

  D. Short periods of apnea

  Correct Answer: A

  The patient who is having Kussmaul respirations would have abnormally deep, regular and increased respirations. Bradypnea would produce regular, slow respirations. Hyperpnea is labored, increased respirations, and apnea is when a patient stops breathing for short periods of time.

• Question 87:

  You are planning to draw an arterial blood gas from your patient, but you must perform an Allen's test first. You know that the Allen's test is used to test what?

  A. Popliteal circulation

  B. Ulnar circulation

  C. Femoral circulation

  D. Carotid circulation

  Correct Answer: B

  The Allen's test is used to test the ulnar circulation prior to drawing blood from an artery. This determines whether there is adequate collateral circulation to the hand prior to drawing the blood. If damage is done to the radial artery with ulnar circulation, the hand could suffer from severe ischemic injury.

• Question 88:

  You have drawn an arterial blood gas on your patient. In reviewing the results you note the following: pH 7.45, PCO2 of 30 mm Hg, and bicarbonate of 22mEq/L. What do you interpret these results to mean?

  A. Metabolic acidosis, compensated

  B. Metabolic alkalosis, compensated

  C. Respiratory acidosis, compensated

  D. Respiratory alkalosis, compensated

  Correct Answer: D

  The arterial blood gas results are indicative of respiratory alkalosis, compensated. In a respiratory condition, pH and PCO2 will display opposite effects. In this instance the patient's pH is at the high end of normal, and PCO2 is low. Compensation occurs when the pH is starting to return to normal, while the PCO2 remains low.

• Question 89:

  You are caring for a patient in respiratory acidosis. Which of the following results confirms this diagnosis?

  A. pH 7.50, PCO2 52 mm Hg

  B. pH 7.35, PCO2 40 mm Hg

  C. pH 7.25, PCO2 50 mm Hg

  D. pH 5.50, PCO2 30 mm Hg

  Correct Answer: C

  The patient with a pH 7.25 and PCO2 50 mm Hg is in respiratory acidosis. A normal pH would be 7.35 to 7.45, and a normal PCO2 is 35 to 45 mm Hg. When looking at the labs, if the patient is in respiratory acidosis the pH will be down, and PCO2 will be elevated.

• Question 90:

  You are caring for a patient with chronic obstructive pulmonary disease (COPD). This patient would be most likely to develop which acid-base imbalance?

  A. Respiratory acidosis

  B. Respiratory alkalosis

  C. Metabolic acidosis

  D. Metabolic alkalosis

  Correct Answer: A

  A patient with COPD would be more likely to develop respiratory acidosis. Hypoventilation by the patient leads to respiratory acidosis. End-stage disease leads to airway collapse, air trapping and disturbance of ventilation- perfusion relationships.