a nurse is assessing a client who has a chest tube and drainage system in place which of the following is an expected finding
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Nursing Elites

ATI RN

ATI Fundamentals

1. During an assessment, a healthcare provider observes a client with a chest tube and drainage system. What is an expected finding?

Correct answer: B

Rationale: When assessing a client with a chest tube and drainage system, gentle constant bubbling in the suction control chamber is an expected finding. This indicates that the system is functioning properly. Continuous bubbling in the water seal chamber would suggest an air leak, the drainage system should be positioned upright at chest level to promote proper drainage, and exposed sutures without dressing would be an incorrect finding as they should be covered to prevent infection.

2. The healthcare provider orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?

Correct answer: C

Rationale: To determine the flow rate in drops per minute, multiply the ordered volume per hour by the drop factor (100 ml/hour x 15 gtt/ml = 1500 gtt/hour). Then, divide the result by 60 minutes to convert it to drops per minute (1500 gtt/hour ÷ 60 minutes = 25 gtt/minute). Therefore, the correct answer is 25 gtt/minute.

3. A healthcare professional is caring for a client who is newly diagnosed with pancreatic cancer and has questions about the disease. To research, the healthcare professional should identify that which of the following electronic databases has the most comprehensive collection of nursing articles?

Correct answer: B

Rationale: CINAHL (Cumulative Index to Nursing and Allied Health Literature) is a comprehensive database that specializes in nursing and allied health literature. It is a valuable resource for healthcare professionals seeking nursing-related articles, making it the most appropriate option for the nurse caring for a client with questions about pancreatic cancer.

4. Which of the following conditions may necessitate fluid restriction?

Correct answer: C

Rationale: Renal failure often necessitates fluid restriction to prevent fluid overload. In renal failure, the kidneys are unable to effectively filter and excrete excess fluids, leading to fluid accumulation in the body. Restricting fluid intake helps manage this condition by preventing further fluid buildup and complications such as edema and electrolyte imbalances.

5. When providing mouth care to an unconscious client, what is the best position for the client?

Correct answer: B

Rationale: The best position for an unconscious client when providing mouth care is the side-lying position. This position helps prevent aspiration by allowing fluids to drain out of the mouth easily, reducing the risk of choking or aspiration pneumonia. Placing the client in a side-lying position also promotes comfort and safety during the procedure. The other options are not ideal for mouth care in an unconscious client: Fowler’s position may increase the risk of aspiration, the supine position can lead to aspiration as well, and Trendelenburg position is not recommended due to potential adverse effects on blood circulation and increased intracranial pressure.

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