Chapter 28 Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson

Chapter 28 Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

A patient is ready to begin weaning from mechanical ventilation. The nurse would prepare to assist respiratory therapy with which procedure?

1. Applying a T-tube set
2. Insertion of a short one-way valve
3. Tracheostomy insertion
4. Insertion of a new endotracheal tube

Correct Answer: 1

Rationale 1: The T-piece or T-tube is placed on the patient’s endotracheal tube and attached to oxygen. The ventilator is removed for short periods and oxygen is delivered using the T-piece. The time the patient is off the ventilator is increased over time.

Rationale 2: One-way valves are used in the treatment of pneumothorax.

Rationale 3: Tracheostomies are performed when patients require long-term mechanical ventilation. They are not performed as part of the weaning process.

Rationale 4: The endotracheal tube is not changed prior to weaning.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28-6

 

Question 2

Type: MCMA

The nurse will assess for which complications in the patient who has a nasal endotracheal tube in place?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Tracheoesophageal fistula
2. Wound infection
3. Pressure necrosis of the nares
4. Sinusitis
5. Obstruction of the tube

Correct Answer: 1,3,4,5

Rationale 1: The patient with a nasal endotracheal tube can develop a tracheoesophageal fistula from the pressure exerted against the tissues by the tube.

Rationale 2: There is no incision or wound associated with an endotracheal tube.

Rationale 3: The patient with a nasal endotracheal tube can experience pressure necrosis of the nares from the pressure exerted against the tissues by the tube.

Rationale 4: The patient with a nasal endotracheal tube can experience sinusitis if sinus drainage is blocked.

Rationale 5: The tube can be displaced or obstructed.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28-6

 

Question 3

Type: MCMA

Which instructions should the nurse include when providing discharge teaching to a patient recovering from acute respiratory distress syndrome (ARDS)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “You should avoid smoking and air pollution.”
2. “Lifestyle modifications to decrease oxygen demands will be necessary.”
3. “It is important for you to restrict fluid intake to avoid congestive failure.”
4. “You and your family should get annual influenza immunizations.”
5. “You must avoid large gatherings of people.”

Correct Answer: 1,2,4

Rationale 1: Pollution and smoke can further damage already traumatized lung tissue and therefore should be avoided.

Rationale 2: The patient will need to make lifestyle modifications to conserve energy and oxygen demands because lung tissues are still recovering from the damage of the disease processes. Exertional dyspnea will continue to increase if additional demands are made on the pulmonary and cardiovascular systems, which have been impacted by the damage from ARDS. Role changes, increased rest, and decreased activities are needed.

Rationale 3: Fluid restriction is not indicated in most cases.

Rationale 4: Immunizations (for pneumonia and flu) are encouraged to minimize additional insults to lung tissue, as the lung tissue will require up to 6 months to recover.

Rationale 5: These patients are not necessarily immunocompromised. This advice would be provided on a case-by-case basis.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28-1

 

Question 4

Type: MCSA

An elderly postoperative patient without known respiratory or central nervous system disease cannot be extubated in the postanesthesia recovery unit due to abnormal ABG results. The patient does not respond to the nurse’s commands and has a respiratory rate of 10. What ABG results might the nurse expect?

1. pH 7.28; PaO₂ 80 mmHg; PaCO₂ 55 mmHg; HCO₃ 22 mmHg; SaO₂ 92%
2. pH 7.35; PaO₂ 58mmHg; PaCO₂ 36 mmHg; HCO₃ 25 mmHg; SaO₂ 85%
3. pH 7.42; PaO₂ 52mmHg; PaCO₂ 45 mmHg; HCO₃ 26 mmHg; SaO₂ 82%
4. pH 7.44; PaO₂ 59mmHg; PaCO₂ 50 mmHg; HCO₃ 25 mmHg; SaO₂ 89%

Correct Answer: 1

Rationale 1: The nurse would expect the oversedated, nonresponsive patient to potentially have hypercapnia resulting from residual intraoperative medications and the inability to rid him- or herself of CO₂.

Rationale 2: These results would indicate hypoxemic respiratory failure, an unlikely finding in a patient with no prior respiratory history.

Rationale 3: These results would indicate hypoxemic respiratory failure, an unlikely finding in a patient with no prior respiratory history.

Rationale 4: These results would indicate hypoxemic respiratory failure, an unlikely finding in a patient with no prior respiratory history.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28-1