Chapter 21 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition


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Chapter 21  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition



Complete Chapter Questions And Answers

Sample Questions


1. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient has been receiving high-flow oxygen therapy for an extended time. What symptoms should the nurse anticipate if the patient were experiencing oxygen toxicity?

  1. A)  Bradycardia and frontal headache
  2. B)  Dyspnea and substernal pain
  3. C)  Peripheral cyanosis and restlessness
  4. D)  Hypotension and tachycardia

Ans: B


Oxygen toxicity can occur when patients receive too high a concentration of oxygen for an extended period. Symptoms of oxygen toxicity include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia, frontal headache, cyanosis, hypotension, and tachycardia are not symptoms of oxygen toxicity.

2. The nurse caring for a patient with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes?

  1. A)  Cognition is decreased.
  2. B)  Daily arterial blood gases (ABGs) are necessary.
  3. C)  Slight tracheal bleeding is anticipated.
  4. D)  The cough reflex is depressed.

Ans: D


There are several disadvantages of an endotracheal tube. Disadvantages include suppression of the patient’s cough reflex, thickening of secretions, and depressed swallowing reflexes. Ulceration and stricture of the larynx or trachea may develop, but bleeding is not an expected finding. The tube should not influence cognition and daily ABGs are not always required.

3. What would the critical care nurse recognize as a condition that may indicate a patient’s need to have a tracheostomy?

  1. A)  A patient has a respiratory rate of 10 breaths per minute.
  2. B)  A patient requires permanent ventilation.
  3. C)  A patient exhibits symptoms of dyspnea.
  4. D)  A patient has respiratory acidosis.

Ans: B


A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed patient. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.

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4. The medical nurse is creating the care plan of an adult patient requiring mechanical ventilation. What nursing action is most appropriate?

  1. A)  Keep the patient in a low Fowler’s position.
  2. B)  Perform tracheostomy care at least once per day.
  3. C)  Maintain continuous bedrest.
  4. D)  Monitor cuff pressure every 8 hours.

Ans: D


The cuff pressure should be monitored every 8 hours. It is important to perform tracheostomy care at least every 8 hours because of the risk of infection. The patient should be encouraged to ambulate, if possible, and a low Fowler’s position is not indicated.

5. The nurse is caring for a patient who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the patient?

  1. A)  How to milk the chest tubing
  2. B)  How to splint the incision when coughing
  3. C)  How to take prophylactic antibiotics correctly
  4. D)  How to manage the need for fluid restriction

Ans: B


Prior to thoracotomy, the nurse educates the patient about how to splint the incision with the hands, a pillow, or a folded towel. The patient is not taught how to milk the chest tubing because this is performed by the nurse. Prophylactic antibiotics are not normally used and fluid restriction is not indicated following thoracotomy.

6. A nurse is educating a patient in anticipation of a procedure that will require a water- sealed chest drainage system. What should the nurse tell the patient and the family that this drainage system is used for?

  1. A)  Maintaining positive chest-wall pressure
  2. B)  Monitoring pleural fluid osmolarity
  3. C)  Providing positive intrathoracic pressure
  4. D)  Removing excess air and fluid

Ans: D


Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood. They are not used to maintain positive chest-wall pressure, monitor pleural fluid, or provide positive intrathoracic pressure.

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