Question 1

Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax?
A) Decreased thoracic volume on the affected side
B) Dull percussion note
C) Tracheal shift away from the affected side
D) Wheezes

Accepted Answer

A tension pneumothorax causes the trachea to shift away from the affected side due to increased pressure in the pleural space pushing the mediastinal structures to the opposite side.

Question 2

A 40-year-old patient requires placement of a thoracostomy chest tube. Which of the following are recommended for the procedure? 1) Application of -5 cm H₂O pressure to the chest tube 2) Use of a No. 28 to 36 French gauge tube 3) Placement of the tube at the apex of the lung 4) Clamping and removing the tube within 24 hours of insertion A)1, 3 B)1, 2, 4 C)2, 3, 4 D)1, 2, 3

Accepted Answer

The recommended practices for the placement of a thoracostomy chest tube include the use of a No. 28 to 36 French gauge tube for adults and the placement of the tube at the apex of the lung for pneumothorax. The application of negative pressure (-5 cm H2O) is also a common practice to facilitate lung expansion and fluid drainage. Clamping and removing the tube within 24 hours of insertion is not a standard recommendation, as the timing for removal depends on the resolution of the pneumothorax or effusion and the cessation of air leaks.

Question 3

What is the primary cause of hypotension in a patient with a large pneumothorax?
A) Pain
B) Decreased venous return to the heart
C) Tracheal compression
D) Atelectasis

Accepted Answer

Decreased venous return to the heart is the primary cause of hypotension in a patient with a large pneumothorax. This occurs because the accumulation of air in the pleural space increases intrathoracic pressure, which in turn impedes the return of blood to the heart, leading to reduced cardiac output and hypotension.

Question 4

Which of the following are anatomic alterations that occur when a person has a pneumothorax?
1) The lung on the affected side collapses.
2) The visceral and parietal pleura separate.
3) The visceral pleura adheres to the parietal pleura.
4) The chest wall moves outward.
A)1, 3
B)3, 4
C)2, 4
D)1, 2, 4

Accepted Answer

1) In a pneumothorax, air enters the pleural space, causing the lung on the affected side to collapse due to loss of negative pressure. 2) Normally, the visceral and parietal pleura are in close contact, but in pneumothorax, they separate because of the air in the pleural space. 4) The chest wall may move outward on the affected side due to the pressure from the air in the pleural space pushing against it.

Question 5

If the patient has a tension pneumothorax, which of the following chest radiograph findings would be expected?
1) Elevated diaphragm
2) Mediastinal shift to the unaffected side
3) Increased translucency on the side of the pneumothorax
4) Atelectasis
A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Accepted Answer

The answer of If the patient has a tension pneumothorax,...

Question 6

A 17-year-old male has been brought to the hospital because he felt short of breath after being tackled in a football game. A chest radiograph shows a broken rib and a pneumothorax in the right lung with pleural space not in direct contact with the atmosphere. Which of the following conditions would be present?
A) Closed pneumothorax
B) Pleural effusion
C) Iatrogenic pneumothorax
D) Sucking chest wound

Accepted Answer

A closed pneumothorax occurs when air enters the pleural space but is not in direct contact with the atmosphere, such as from a broken rib puncturing the lung, as described in the scenario.

Question 7

According to the way gas enters the pleural space, a pneumothorax will be classified as:
1) intrinsic.
2) extrinsic.
3) open.
4) closed.
A)2, 3
B)1, 4
C)3, 4
D)1, 2

Accepted Answer

Pneumothorax is classified based on how air enters the pleural space, with "open" referring to air entering through an opening in the chest wall and "closed" referring to air leaking from the lung into the pleural space without an external opening.

Question 8

Which of the following hemodynamic indices will be found in a patient with a large hemothorax? A) Decreased Q_S/Q_T B) Decreased CO C) Increased CI D) Increased SV

Accepted Answer

A large hemothorax can lead to significant blood loss, resulting in decreased cardiac output (CO) as the heart has less blood volume to pump.

Question 9

A pneumothorax manifests itself clinically as a primary _____ disorder.
A) restrictive
B) obstructive
C) restrictive disorder with a secondary obstructive
D) obstructive disorder with secondary restrictive

Accepted Answer

A pneumothorax, which is the presence of air in the pleural space causing lung collapse, primarily leads to a restrictive disorder because it restricts lung expansion.

Question 10

A sucking chest wound would be classified as a(n) _____ pneumothorax.
A) open
B) closed
C) iatrogenic
D) valvular

Accepted Answer

A sucking chest wound is classified as an open pneumothorax because it involves an opening in the chest wall that allows air to enter the pleural space directly from the outside.

Question 11

An iatrogenic pneumothorax may be caused by:
1) positive-pressure mechanical ventilation.
2) pleural biopsy
3) subclavian vein cannulation.
4) endotracheal intubation.
A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Accepted Answer

Iatrogenic pneumothorax can occur as a complication of medical procedures that involve the chest or lungs. Positive-pressure mechanical ventilation can lead to barotrauma causing pneumothorax. Pleural biopsy and subclavian vein cannulation are invasive procedures that can inadvertently puncture the lung, leading to pneumothorax. Endotracheal intubation, while primarily involving the airway, typically does not directly cause pneumothorax unless complicated by improper technique or associated procedures.

Question 12

Which type of untreated pneumothorax is considered to be the most serious?
A) Spontaneous
B) Tension
C) Malignant
D) Iatrogenic

Accepted Answer

Tension pneumothorax is considered the most serious type because it can rapidly progress to life-threatening respiratory or cardiac failure. It occurs when air enters the pleural space and cannot escape, leading to increased pressure that compresses the lung and shifts mediastinal structures, potentially compromising venous return to the heart.

Question 13

After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended a procedure to reduce the occurrence of future pneumothoraces. Which procedure would the physician have recommended?
A) Pleurodesis
B) Right pneumonectomy
C) Permanent right-sided thoracostomy tube
D) Right upper lobectomy

Accepted Answer

Pleurodesis is a medical procedure that causes the pleura around the lung to stick together and prevents the occurrence of pneumothorax (collapsed lung). It is commonly recommended after recurrent pneumothoraces to prevent future episodes.

Question 14

A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath. The pain originated while she participated in deep breathing exercises in a yoga class. The physician has determined that she has a 15% pneumothorax. How should the pneumothorax be classified?
A) Open
B) Exercise related
C) Spontaneous
D) Traumatic

Accepted Answer

The pneumothorax described occurred spontaneously during a non-strenuous activity (yoga) without any external chest trauma, classifying it as a spontaneous pneumothorax.

Question 15

Which type of pneumothorax would result from the rupture of bulla on the surface of a lung?
A) Spontaneous pneumothorax
B) Iatrogenic pneumothorax
C) Open pneumothorax
D) Visceral pneumothorax

Accepted Answer

Spontaneous pneumothorax occurs when an air-filled blister on the lung surface, known as a bulla, ruptures without any apparent cause, such as trauma or medical procedures. This leads to air escaping into the space between the lung and chest wall, causing the lung to collapse.

Question 16

A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called:
A) panting.
B) paradoxical movement.
C) bidirectional flow.
D) pendelluft.

Accepted Answer

Pendelluft is the term used to describe the movement of gas from one lung to another in situations like a pneumothorax with a sucking chest wound. This phenomenon occurs when there is a pressure difference between the two lungs, causing air to move from the higher pressure lung to the lower pressure lung.

Question 17

A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition?
A) Spontaneous pneumothorax
B) Tension pneumothorax
C) Iatrogenic pneumothorax
D) Benign pneumothorax

Accepted Answer

A valvular pneumothorax that allows air to enter the pleural space on inspiration but not to escape on expiration is known as a tension pneumothorax. This condition can lead to increased intrathoracic pressure, compressing the heart and major blood vessels, and is a medical emergency.

Quiz 23: Pneumothorax

Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax?

What is the primary cause of hypotension in a patient with a large pneumothorax?

Which of the following are anatomic alterations that occur when a person has a pneumothorax? 1) The lung on the affected side collapses. 2) The visceral and parietal pleura separate. 3) The visceral pleura adheres to the parietal pleura. 4) The chest wall moves outward.

If the patient has a tension pneumothorax, which of the following chest radiograph findings would be expected? 1) Elevated diaphragm 2) Mediastinal shift to the unaffected side 3) Increased translucency on the side of the pneumothorax 4) Atelectasis

According to the way gas enters the pleural space, a pneumothorax will be classified as: 1) intrinsic. 2) extrinsic. 3) open. 4) closed.

Which of the following hemodynamic indices will be found in a patient with a large hemothorax?

A pneumothorax manifests itself clinically as a primary _____ disorder.

A sucking chest wound would be classified as a(n) _____ pneumothorax.

An iatrogenic pneumothorax may be caused by: 1) positive-pressure mechanical ventilation. 2) pleural biopsy 3) subclavian vein cannulation. 4) endotracheal intubation.

Which type of untreated pneumothorax is considered to be the most serious?

After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended a procedure to reduce the occurrence of future pneumothoraces. Which procedure would the physician have recommended?

Which type of pneumothorax would result from the rupture of bulla on the surface of a lung?

A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called:

A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition?