When caring for a client with a chest tube, the nurse would avoid the practice

Encouraging the client to cough and deep breathe every two hours.

Striping the chest tube to dislodge any blood clots

Assessing the client's respiratory status frequently

Monitoring skin for subcutaneous emphysema

Answer and Explanation

The Correct Answer is B

A) Encouraging the client to cough and deep breathe every two hours:
Encouraging the client to cough and deep breathe is an important nursing intervention for clients with a chest tube. This helps promote lung expansion, prevent atelectasis, and improve respiratory function. It also helps to clear secretions that may accumulate in the lungs. Therefore, this practice is appropriate and beneficial for the client.

B) Stripping the chest tube to dislodge any blood clots:
Stripping the chest tube, which involves forcibly pulling or pinching the tubing to remove clots, is an unsafe and outdated practice. It can create a dangerous increase in intrathoracic pressure, which may lead to tension pneumothorax, as well as injury to the lung tissue. Instead, the nurse should focus on gently milking the chest tube if necessary (if prescribed by the healthcare provider) or ensure that any blood clots are properly managed by the physician. Stripping or clamping the tube without proper indications is contraindicated.

C) Assessing the client's respiratory status frequently:
Frequent assessment of the client's respiratory status is crucial when managing a patient with a chest tube. The nurse should monitor for signs of respiratory distress, changes in breath sounds, oxygen saturation, and any signs of complications such as pneumothorax or hemothorax. Regular respiratory assessment helps in early detection of issues and provides the data necessary to manage the client's care effectively.

D) Monitoring skin for subcutaneous emphysema:
Monitoring for subcutaneous emphysema is a vital part of nursing care for a client with a chest tube. Subcutaneous emphysema occurs when air escapes from the pleural space into the tissues under the skin, and can be a sign of a pneumothorax or a complication related to the chest tube. It is important to detect this early so appropriate intervention can be made to prevent further complications.

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Correct Answer is D

Explanation

A. Resume smoking initially to help manage stress and anxiety:
Smoking is a significant risk factor for cardiovascular disease and can worsen the prognosis after coronary artery bypass graft (CABG) surgery. Smoking increases the risk of coronary artery disease and impairs healing after surgery. Therefore, advising the client to resume smoking, even temporarily, is unsafe and completely contrary to health recommendations for post-CABG care. Smoking cessation should be emphasized as a key part of the recovery process.

B. Consume a high-fat diet to promote weight gain and energy:
A high-fat diet is not recommended for individuals with coronary artery disease, especially after CABG surgery. Consuming a diet high in saturated fats and cholesterol can lead to further plaque buildup in the coronary arteries, increasing the risk of atherosclerosis and cardiac events. After CABG, patients are typically encouraged to follow a heart-healthy diet that is low in saturated fat, high in fiber, and rich in fruits, vegetables, and lean proteins to support overall heart health and recovery.

C. Avoid physical activity and rest as much as possible:
While rest is essential immediately following surgery, complete avoidance of physical activity is not advisable long-term. In fact, early and gradual physical activity is a key component of rehabilitation after CABG surgery. A sedentary lifestyle can increase the risk of complications such as blood clots, muscle weakness, and weight gain, while physical activity helps improve circulation, heart function, and overall recovery. The nurse should encourage the client to gradually resume physical activity according to the guidance of their healthcare provider, often starting with light walking and progressing as tolerated.

D. Continue taking all prescribed medications as directed: Following coronary artery bypass graft (CABG) surgery, it is essential for the client to continue taking all prescribed medications, including antiplatelets, statins, beta-blockers, and any other medications ordered by the healthcare provider. These medications play a critical role in preventing blood clots, controlling blood pressure, reducing cholesterol levels, and preventing future cardiac events. Stopping or altering medications without consulting a healthcare provider could increase the risk of complications or recurrent cardiac events.

A. Partially compensated metabolic alkalosis B. Partially compensated respiratory acidosis C. Fully compensated metabolic alkalosis D. Fully compensated respiratory acidosis

Correct Answer is B

Explanation

A. Partially compensated metabolic alkalosis:
Metabolic alkalosis is characterized by elevated bicarbonate levels (HCO3), but in this case, the HCO3 is elevated (29 mEq/L), which suggests alkalosis. However, the PaCO2 is elevated at 47 mmHg, which is more consistent with a respiratory problem. A fully or partially compensated metabolic alkalosis would show a normal or low PaCO2 (due to respiratory compensation). Therefore, this option does not fit the ABG results.

B. Partially compensated respiratory acidosis: In this case, the pH is 7.17, which is low and indicates acidosis. The PaCO2 is 47 mmHg, which is elevated (normal range: 35-45 mmHg), indicating that the respiratory system is contributing to the acidosis. The HCO3 is 29 mEq/L, which is elevated (normal range: 22-26 mEq/L), suggesting a compensatory response from the kidneys to retain bicarbonate in an attempt to buffer the acidosis. Since the pH is still below normal and has not yet returned to the normal range (7.35-7.45), this suggests that the compensation is partial and the primary issue is respiratory acidosis.

C. Fully compensated metabolic alkalosis:
This answer is incorrect because metabolic alkalosis is not the primary disturbance here. Also, for a condition to be fully compensated, the pH would need to be within the normal range (7.35-7.45). Since the pH is 7.17, the condition is not fully compensated.

D. Fully compensated respiratory acidosis:
For fully compensated respiratory acidosis, the pH should be within the normal range, as the kidneys would have fully compensated for the elevated PaCO2. Since the pH is 7.17, this is a sign of partial compensation, not full compensation. Therefore, this option is incorrect.

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When caring for a client with a chest tube, the nurse would avoid the practice

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

Correct Answer is B

Explanation

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