What should be the first intervention when a nurse finds that a patient has fallen quizlet?

This is a quiz that contains NCLEX review questions for pneumothorax. Patients who have a pneumothorax have built up pressure in the intrapleural space which causes the lung to collapse.

In the previous NCLEX review series, I explained about other disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.

As the nurse, it is important to know how to care for a patient with pneumothorax. In addition, the nurse needs to be aware of the causes, risk factors, and management of pneumothorax.

Also be sure to take the quiz on chest tube care which goes along with the nursing interventions for pneumothorax.

The NCLEX exam loves to ask questions about the different types of pneumothorax, major signs and symptoms, and nursing interventions .

This quiz will test you on:

  • Types of pneumothorax
  • Signs and Symptoms of pneumothorax
  • Nursing Interventions

Pneumothorax NCLEX Questions

This quiz will test your nursing knowledge about pneumothorax in preparation for the NCLEX exam.

  • 1. A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?*

    • A. Closed pneumothorax
    • B. Open pneumothorax
    • C. Tension pneumothorax
    • D. Spontaneous pneumothorax

  • 2. In regards to the patient in the question above, which of the following options below is a nursing intervention you would provide to this patient?*

    • A. Place the patient in supine position
    • B. Place a non-occlusive dressing over the chest wound
    • C. Place a sterile occlusive dressing over the chest wound and tape it on three sides
    • D. Prepare the patient for a thoracentesis

  • 3. A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?*

    • A. It can be caused by the rupture of a pulmonary bleb.
    • B. It can occur in patients who are young, tall and thin without a history of lung disease.
    • C. Smoking increases the chances of a patient developing a spontaneous pneumothorax.
    • D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.

  • 4. Which of the following is a LATE sign of the development of a tension pneumothorax?*

    • A. Hypotension
    • B. Tachycardia
    • C. Tracheal deviation
    • D. Dyspnea

  • 5. While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient’s skin that appear to be “bulging” out. These “bulging” areas are located on the patient’s neck, face, and abdomen. On palpation on these areas, you note they feel "crunchy". When charting your findings you would refer to this finding as?*

    • A. Subcutaneous paresthesia
    • B. Pigment molle
    • C. Subcutaneous emphysema
    • D. Veisalgia

  • 6. You're providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action?*

    • A. Keep monitoring the patient because this is a normal finding.
    • B. Increase wall suction to the system until the water fluctuates in the water seal chamber.
    • C. Assess patient's lung sounds to assess if the affected lung has re-expanded.
    • D. Notify the physician.

  • 7. A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition:*

    • A. Hypotension
    • B. Jugular Venous Distention
    • C. Bradycardia
    • D. Tracheal deviation
    • E. Hyperemia
    • F. Tachypnea

  • 8. A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?*

    • A. The water seal chamber has intermittent bubbling.
    • B. The patient has slight tracheal deviation to the right side.
    • C. The water seal chamber fluctuates while the patient inhales and exhales.
    • D. The patient complains of tenderness at the chest tube insertion site.

  • 9. Which statement is CORRECT about a tension pneumothorax?*

    • A. This condition happens when an opening to the intrapleural space creates a two-way valve which causes pressure to build up in the space leading to shifting of the mediastinum.
    • B. A tension pneumothorax is a medical emergency and is treated with needle decompression.
    • C. Tracheal deviation is an early sign of a tension pneumothorax
    • D. An open pneumothorax is the only cause of a tension pneumothorax.

  • 10. A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side, and there is a large crack in the system. What is your next PRIORITY?*

    • A. Place the patient in supine position and clamp the tubing.
    • B. Notify the physician immediately.
    • C. Disconnect the drainage system and get a new one.
    • D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your result)

Lecture on Pneumothorax

Pneumothorax NCLEX Question Quiz

1. A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a “sucking” sound when the patient inhales and exhales. The patient’s chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?

A. Closed pneumothorax

B. Open pneumothorax

C. Tension pneumothorax

D. Spontaneous pneumothorax

2. In regards to the patient in the question above, which of the following options below is a nursing intervention you would provide to this patient?

A. Place the patient in supine position

B. Place a non-occlusive dressing over the chest wound

C. Place an occlusive dressing over the chest wound and tape it on three sides

D. Prepare the patient for a thoracentesis

3. A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?

A. It can be caused by the rupture of a pulmonary bleb.

B. It can occur in patients who are young, tall and thin without a history of lung disease.

C. Smoking increases the chances of a patient developing a spontaneous pneumothorax.

D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.

4. Which of the following is a LATE sign of the development of a tension pneumothorax?

A. Hypotension

B. Tachycardia

C. Tracheal deviation

D. Dyspnea

5. While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient’s skin that appear to be “bulging” out. These “bulging” areas are located on the patient’s neck, face, and abdomen. On palpation on these areas, you note they feel “crunchy”. When charting your findings you would refer to this finding as?

A. Subcutaneous paresthesia

B. Pigment molle

C. Subcutaneous emphysema

D. Veisalgia

6. You’re providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action?

A. Keep monitoring the patient because this is a normal finding.

B. Increase wall suction to the system until the water fluctuates in the water seal chamber.

C. Assess patient’s lung sounds to assess if the affected lung has re-expanded.

D. Notify the physician.

7. A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition:

A. Hypotension

B. Jugular Venous Distention

C. Bradycardia

D. Tracheal deviation

E. Hyperemia

F. Tachypnea

8. A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?

A. The water seal chamber has intermittent bubbling.

B. The patient has slight tracheal deviation to the right side.

C. The water seal chamber fluctuates while the patient inhales and exhales.

D. The patient complains of tenderness at the chest tube insertion site.

9. Which statement is CORRECT about a tension pneumothorax?

A. This condition happens when an opening to the intrapleural space creates a two-way valve which causes pressure to build up in the space leading to shifting of the mediastinum.

B. A tension pneumothorax is a medical emergency and is treated with needle decompression.

C. Tracheal deviation is an early sign of a tension pneumothorax

D. An open pneumothorax is the only cause of a tension pneumothorax.

10. A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side and there is a large crack in the system. What is your next PRIORITY?

A. Place the patient in supine position and clamp the tubing.

B. Notify the physician immediately.

C. Disconnect the drainage system and get a new one.

D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

Answer Key:

1. B
2. C
3. D
4. C
5. C
6. C
7. A, B, D, F
8. B
9. B
10. D

More NCLEX Quizzes

What should be the first intervention when a nurse finds that a patient has fallen quizlet?

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What is the first thing that should be done when a patient falls?

Stay with the patient and call for help. Check the patient's breathing, pulse, and blood pressure. If the patient is unconscious, not breathing, or does not have a pulse, call a hospital emergency code and start CPR. Check for injury, such as cuts, scrapes, bruises, and broken bones.

What is the first step in preventing falls for a patient quizlet?

Avoid exercise. The patient who is at risk for falls must have rails to hold to prevent falling.

What are some nursing interventions for falls?

Interventions to Prevent Falls.
Familiarize the patient with the environment..
Have the patient demonstrate call light use..
Maintain the call light within reach. ... .
Keep the patient's personal possessions within safe reach..
Have sturdy handrails in patient bathrooms, rooms, and hallways..

What general action can the nurse assistant take to reduce a person's risk of falling?

The CNA can prevent falls by promptly meeting the basic needs of patients. When basic needs are met regularly and frequently, patients will be less inclined to try to reach something themselves and risk falling.