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A patient with a hemopneumothorax had a chest tube placed 5 hours ago. During assessment of the drainage system, the nurse notes an absence of fluid fluctuation (tidaling) in the water-seal chamber. What should the nurse suspect?
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Drainage system is working properly
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An air leak is present within the system
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Drainage system is blocked
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Hemopneumothorax has resolved
Explanation
Correct answer: C. Drainage system is blocked
Tidaling normally occurs in the water-seal chamber as the patient breathes because of pressure changes in the pleural space. If tidaling suddenly stops soon after chest tube insertion, it may indicate an obstruction or blockage in the tubing, such as a clot or kink. The nurse should assess the system immediately.
A patient with DKA has a blood glucose of 620 mg/dL, K 4.5 mEq/L, pH 7.22, and positive ketones. What is the nurse’s priority action?
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Administer subcutaneous insulin
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Give oral potassium supplements
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Begin sodium bicarbonate therapy
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Start an IV infusion of insulin
Explanation
Correct answer: D. Start an IV infusion of insulin
Diabetic ketoacidosis occurs because of severe insulin deficiency, leading to hyperglycemia, ketosis, and metabolic acidosis. The priority treatment is continuous IV insulin infusion, which stops ketone production and lowers blood glucose levels.
Potassium levels should be monitored closely, but with a potassium level of 4.5 mEq/L, immediate potassium replacement is not the priority. Sodium bicarbonate is usually reserved for severe acidosis (pH < 6.9).
A patient is admitted with symptoms of edema, bradycardia, and lethargy. The nurse understands based on these symptoms which of the following can cause myxedema coma?
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Untreated hypothyroidism
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Uncontrolled diabetes
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End-stage Graves’ disease
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Overdose of propylthiouracil
Explanation
Correct answer: A. Untreated hypothyroidism
Myxedema coma is a life-threatening complication of severe, untreated hypothyroidism. It occurs when thyroid hormone levels become extremely low, leading to decreased metabolic activity, hypothermia, bradycardia, edema, lethargy, and altered mental status. The condition represents the most severe form of hypothyroidism and requires immediate treatment with IV thyroid hormone and supportive care.
A nurse is caring for a patient with renal disease and has a GFR of less than 15 mL/min. The nurse knows that the GFR level indicates the need for which intervention?
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Daily weight and fluid restrictions.
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Hemodialysis or peritoneal dialysis.
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Dietary restrictions and antihypertensive medications.
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Increase of phosphate and calcium supplements.
Explanation
Correct Answer: B) Hemodialysis or peritoneal dialysis.
A GFR of less than 15 mL/min indicates Stage 5 chronic kidney disease (CKD), also known as end-stage renal disease (ESRD). At this level, the kidneys have lost nearly all of their functional capacity and can no longer adequately filter waste, regulate electrolytes, or manage fluid balance.
Renal replacement therapy — either hemodialysis or peritoneal dialysis — becomes necessary to sustain life. Daily weight monitoring, fluid restrictions, dietary changes, and antihypertensive medications are appropriate in earlier stages of CKD, but a GFR below 15 specifically signals the need for dialysis. Phosphate levels are typically restricted, not increased, in advanced renal disease.
When caring for a patient with a head injury, a nurse must stay alert for signs and symptoms of increased intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP?
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Hypertension and narrowing pulse pressure.
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Elevated systolic blood pressure and bradycardia.
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Hypotension and tachycardia.
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Hypotension and bradycardia.
Explanation
Correct Answer: B) Elevated systolic blood pressure and bradycardia.
The Cushing's triad is the classic late sign of severely increased ICP, consisting of elevated systolic blood pressure (with widening pulse pressure), bradycardia, and irregular respirations. The rise in systolic BP is the body's attempt to maintain cerebral perfusion pressure against the increasing intracranial pressure, while bradycardia results from vagal stimulation. This is a grave, late finding indicating impending brainstem herniation requiring immediate intervention. Hypotension and tachycardia are signs of systemic shock, not increased ICP. Narrowing pulse pressure and hypotension are inconsistent with the Cushing's response.
A patient accidentally steps on the chest tube drainage system and breaks the system. The nurse will immediately perform which action?
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Turn off suction and have the patient take deep breaths.
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Clamp the chest tube and reassure the patient.
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Assess lung sounds and administer oxygen via nasal cannula.
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Place the end of the chest tube into sterile water.
Explanation
Correct answer: D. Place the end of the chest tube into sterile water
If the chest drainage system becomes disconnected or broken, the nurse must quickly re-establish a water seal to prevent air from entering the pleural space and causing a pneumothorax. Placing the end of the chest tube into sterile water temporarily creates a water seal until a new drainage system can be attached.
The nurse is assessing a patient with multiple traumas, who is at risk for developing respiratory distress syndrome. What assessment finding does the nurse expect as an early sign of respiratory distress syndrome?
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Intercostal retractions
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Bilateral wheezing
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Increased respiratory rate
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Inspiratory crackles
Explanation
Correct answer: C. Increased respiratory rate
The earliest sign of respiratory distress syndrome (ARDS) is tachypnea (increased respiratory rate). As oxygen exchange becomes impaired due to inflammation and fluid accumulation in the alveoli, the body attempts to compensate by increasing the breathing rate to improve oxygen delivery.
Other findings such as intercostal retractions, inspiratory crackles, and severe respiratory distress tend to appear later as the condition worsens and the lungs become less compliant. Early recognition of tachypnea is important so that prompt treatment and supportive respiratory interventions can be initiated.
During the emergent phase of burn care, which nursing action will be most useful in determining if a patient is receiving adequate fluid resuscitation?
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Measure hourly urine output.
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Monitor daily weight.
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Check skin turgor.
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Assess mucous membranes.
Explanation
Correct Answer: A) Measure hourly urine output.
Hourly urine output is the most reliable and sensitive indicator of adequate fluid resuscitation in burn patients during the emergent phase. The goal is to maintain urine output of 0.5–1 mL/kg/hour in adults, which reflects adequate renal perfusion and overall tissue perfusion. Daily weight, skin turgor, and mucous membrane assessment provide useful but less precise and less immediate information about fluid status compared to hourly urine monitoring.
The nurse is teaching about fire safety. Which prevention strategy will the nurse focus on?
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Encourage regular work and home fire exit drills.
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Never allow older adults to cook unsupervised.
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Hard wire all smoke detectors.
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Set hot water temp to 140 degrees F.
Explanation
Correct Answer: A) Encourage regular work and home fire exit drills.
Practicing regular fire exit drills at home and work is the most effective and universally applicable fire prevention and safety strategy, ensuring that people know how to evacuate quickly and safely in an emergency. Restricting older adults from unsupervised cooking is overly restrictive and not evidence-based as a primary safety strategy. Hard-wiring smoke detectors is beneficial but not always feasible; battery-operated detectors are equally effective when maintained. Hot water temperature should be set to 120°F or below — 140°F actually increases the risk of scald burns, particularly in children and older adults.
A nurse is caring for a patient with acute respiratory failure. The nurse understands that which pathophysiologic process is primarily responsible for this condition?
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Occurs when oxygenation, ventilation or both are inadequate.
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Increased functional residual capacity leading to air trapping.
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Bronchoconstriction and decreasing airflow in and out of the lungs.
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Inflammatory mediators that release histamine and lead to inflammation of airways.
Explanation
Correct answer: A. Occurs when oxygenation, ventilation or both are inadequate
Acute respiratory failure occurs when the respiratory system cannot maintain adequate oxygenation (PaO₂) or ventilation (PaCO₂). This results in either hypoxemic respiratory failure, hypercapnic respiratory failure, or both.
The other options describe specific conditions such as COPD, asthma, or allergic airway inflammation, rather than the general mechanism of respiratory failure.
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