2 - 2 Pleural Effusion

Question 1

1. Which primary symptom is most commonly reported by clients with pleural effusion?
   A. Dyspnea on exertion or at rest
   D. Productive cough with green sputum
   C. Sudden hemoptysis
   B. Inspiratory stridor

Answer 1

Dyspnea occurs due to fluid compression of lung tissue, reducing lung expansion. Cough and stridor are less typical.

Question 2

2. A client with pleural effusion reports sharp chest pain that worsens with inspiration. What is this symptom called?
   A. Pleuritic pain
   D. Visceral pain
   C. Musculoskeletal pain
   B. Radiating cardiac pain

Answer 2

Pleuritic pain is sharp and increases with deep breathing or coughing due to inflamed pleura.

Question 3

3. Upon chest percussion, what sound indicates the presence of fluid in the pleural space?
   A. Dullness
   D. Resonance
   C. Hyperresonance
   B. Tympany

Answer 3

Dullness is heard over fluid-filled areas, unlike resonance over normal lung tissue.

Question 4

4. Which breath sound finding is typical in pleural effusion?
   A. Diminished or absent breath sounds over the affected area
   D. Crackles and rhonchi bilaterally
   C. Wheezing in all lobes
   B. Harsh bronchial sounds

Answer 4

Decreased or absent sounds occur because fluid blocks transmission of breath sounds.

Question 5

5. Which diagnostic imaging test is most commonly used to confirm pleural effusion?
   A. Chest X-ray
   D. PET scan
   C. Echocardiogram
   B. Ultrasound only

Answer 5

Chest X-ray is the first-line tool; it shows fluid accumulation and blunting of the costophrenic angle.

Question 6

6. On a chest X-ray, what characteristic finding indicates pleural effusion?
   A. Blunting of costophrenic angle
   D. Hyperinflated lung fields
   C. Honeycomb pattern
   B. Patchy consolidation

Answer 6

Blunting of the costophrenic angle and meniscus sign are hallmark X-ray findings.

Question 7

7. A nurse notes that the trachea is deviated away from the affected side. This indicates:
   A. Large pleural effusion causing mediastinal shift
   D. Simple pneumothorax
   C. Atelectasis on same side
   B. Normal finding

Answer 7

A massive effusion can push mediastinal structures away from the fluid-filled side.

Question 8

8. What is the expected finding on tactile fremitus in a patient with moderate pleural effusion?
   A. Decreased or absent fremitus over fluid area
   D. Increased fremitus
   C. Normal vibration
   B. Bilateral symmetry

Answer 8

Fluid dampens vibrations, leading to decreased fremitus over affected areas.

Question 9

9. Which test definitively determines whether a pleural effusion is transudative or exudative?
   A. Pleural fluid analysis using Light’s criteria
   D. Chest CT
   C. ECG
   B. Spirometry

Answer 9

Light’s criteria compare pleural and serum protein/LDH to classify effusion type.

Question 10

10. Which finding on pleural fluid analysis indicates an exudative effusion?
    A. Pleural fluid protein/serum protein ratio > 0.5
    D. Pleural fluid glucose > 60 mg/dL
    C. pH 7.4
    B. Low LDH level

Answer 10

An elevated protein ratio (>0.5) and high LDH are diagnostic of exudates.

Question 11

11. Which bedside diagnostic procedure both removes and analyzes pleural fluid?
    A. Thoracentesis
    D. Bronchoscopy
    C. Mediastinoscopy
    B. Thoracotomy

Answer 11

Thoracentesis is used for both diagnostic and therapeutic pleural fluid removal.

Question 12

12. A client with a small effusion may have which auscultatory finding at lung bases?
    A. Diminished breath sounds
    D. Fine crackles
    C. Wheezing
    B. Bronchial sounds

Answer 12

Small effusions often present with decreased sounds due to early fluid buildup.

Question 13

13. A nurse is assessing a client with suspected pleural effusion. Which finding supports the diagnosis?
    A. Decreased chest expansion on the affected side
    D. Increased tactile fremitus
    C. Equal chest excursion
    B. Loud vesicular sounds

Answer 13

Chest expansion decreases on the fluid-filled side because of restricted lung movement.

Question 14

14. When analyzing pleural fluid, a milky white appearance indicates:
    A. Chylothorax (lymphatic fluid leakage)
    D. Empyema
    C. Transudative effusion
    B. Malignant effusion

Answer 14

Chylothorax occurs when lymphatic fluid enters the pleural space, producing a milky appearance.

Question 15

15. Which pleural fluid characteristic indicates possible infection or empyema?
    A. Purulent or foul-smelling appearance
    D. Clear, straw-colored fluid
    C. Bloody effusion
    B. Milky white

Answer 15

Purulent or foul-smelling fluid signifies infection or empyema formation.

Question 16

16. Which noninvasive imaging tool is best for guiding thoracentesis?
    A. Ultrasound
    D. MRI
    C. PET scan
    B. Fluoroscopy

Answer 16

Ultrasound safely localizes fluid and reduces procedure risk during thoracentesis.

Question 17

17. Which clinical sign differentiates pleural effusion from pulmonary edema?
    A. Dullness to percussion and reduced breath sounds localized to one side
    D. Bilateral crackles with frothy sputum
    C. Wheezing with cough
    B. Pink sputum

Answer 17

Pleural effusion causes localized dullness; pulmonary edema presents bilaterally.

Question 18

18. Which laboratory test may identify infection as the cause of effusion?
    A. Pleural fluid culture and Gram stain
    D. Serum LDH
    C. Arterial blood gases
    B. CBC alone

Answer 18

Pleural fluid culture identifies bacterial pathogens confirming empyema.

Question 19

19. Which patient complaint suggests increasing pleural effusion volume?
    A. Worsening shortness of breath and orthopnea
    D. Decreased fatigue
    C. Relief with deep breathing
    B. Loud productive cough

Answer 19

Dyspnea and orthopnea progress as fluid compresses the lung further.

Question 20

20. What is a typical finding on chest auscultation above the level of the effusion?
    A. Bronchial breath sounds
    D. Crackles
    C. Wheezes
    B. Pleural rub

Answer 20

Bronchial breath sounds may be heard above fluid due to lung compression.

Question 21

21. Which diagnostic tool best quantifies pleural fluid volume and detects small effusions?
    A. Chest CT scan
    D. Chest X-ray (PA view)
    C. Ultrasound only
    B. Spirometry

Answer 21

CT scanning provides accurate assessment of fluid location and volume.

Question 22

22. Which pleural fluid characteristic is consistent with malignancy?
    A. Presence of cancer cells on cytology
    D. High glucose level
    C. Clear straw color
    B. Low LDH

Answer 22

Cytology showing malignant cells confirms malignant effusion.

Question 23

23. What is the expected finding in severe pleural effusion on inspection?
    A. Asymmetrical chest expansion with lag on affected side
    D. Barrel chest
    C. Use of accessory muscles bilaterally
    B. Tracheal tugging

Answer 23

Fluid restricts expansion, causing uneven chest movement.

Question 24

24. When listening to breath sounds in a patient with pleural effusion, the nurse may note:
    A. Decreased or absent sounds with egophony above fluid level
    D. Fine crackles throughout lungs
    C. Wheezes only
    B. Normal vesicular sounds

Answer 24

Absent sounds over fluid with egophony above it are hallmark findings.

Question 25

25. Which diagnostic test helps assess pleural thickening or tumor infiltration after effusion? A. CT or pleural biopsy D. ABG analysis C. Chest X-ray only B. Sputum test

Answer 25

CT and pleural biopsy detect malignant or fibrotic pleural changes after effusion.

Question 26

1. Which class of medications is commonly prescribed to reduce pleural effusion caused by congestive heart failure? A. Diuretics (e.g., furosemide) D. Antibiotics C. Corticosteroids B. Anticoagulants

Answer 26

Diuretics relieve fluid overload and reduce hydrostatic pressure, decreasing transudative effusion formation in CHF.

Question 27

2. What is the primary purpose of administering antibiotics in pleural effusion? A. Treat underlying infectious cause such as pneumonia or empyema D. Increase fluid reabsorption C. Prevent pulmonary embolism B. Reduce inflammation only

Answer 27

Antibiotics treat bacterial infections responsible for parapneumonic effusion or empyema.

Question 28

3. Which medication may be used to reduce inflammation in autoimmune or malignant pleural effusion? A. Corticosteroids D. Loop diuretics C. Bronchodilators B. Antihistamines

Answer 28

Corticosteroids decrease pleural inflammation in autoimmune and certain malignant effusions.

Question 29

4. What is the purpose of pleurodesis in recurrent pleural effusions? A. Obliterate pleural space to prevent fluid reaccumulation D. Drain fluid temporarily C. Replace pleural fluid B. Improve lymphatic flow

Answer 29

Pleurodesis fuses pleural layers using agents (e.g., talc), preventing recurrent effusions.

Question 30

5. Which pharmacologic agent is commonly used for chemical pleurodesis? A. Talc slurry D. Furosemide C. Heparin B. Ceftriaxone

Answer 30

Talc induces pleural inflammation and adhesion, effectively preventing recurrence.

Question 31

6. Which type of effusion typically requires both antibiotics and chest tube drainage? A. Empyema (infected pleural fluid) D. Transudative CHF effusion C. Hepatic hydrothorax B. Chylothorax

Answer 31

Empyema requires antibiotics and chest tube drainage to remove pus and infection.

Question 32

7. What is the therapeutic goal of thoracentesis? A. Relieve dyspnea and obtain diagnostic fluid sample D. Expand alveoli permanently C. Replace fluid B. Prevent cough reflex

Answer 32

Thoracentesis removes fluid to relieve compression and allows analysis of pleural fluid.

Question 33

8. Which analgesic intervention best supports comfort during pleural effusion treatment? A. Administer prescribed pain medication before deep-breathing exercises D. Avoid all narcotics C. Encourage fasting B. Apply ice pack only

Answer 33

Administering analgesia before breathing exercises encourages participation and reduces pain.

Question 34

9. Which medication may be given before pleurodesis to manage discomfort? A. Local anesthetic or systemic analgesic D. Antibiotic prophylaxis C. Diuretic B. Bronchodilator

Answer 34

Analgesics or anesthetics are administered to manage pleuritic pain during pleurodesis.

Question 35

10. For patients with malignant pleural effusion, which treatment provides long-term symptom relief? A. Indwelling pleural catheter placement D. Frequent thoracentesis only C. High-dose diuretics B. Chest physiotherapy

Answer 35

Indwelling pleural catheters allow continuous outpatient drainage for recurrent malignant effusions.

Question 36

11. Why is fluid removal during thoracentesis limited to 1–1.5 liters at a time? A. Prevent re-expansion pulmonary edema D. Prevent dehydration C. Avoid hypotension only B. Reduce risk of infection

Answer 36

Rapid large-volume removal may cause re-expansion pulmonary edema and hemodynamic instability.

Question 37

12. Which medication supports pleural effusion treatment related to tuberculosis? A. Anti-tuberculosis drugs (e.g., isoniazid, rifampin) D. Antifungals C. Corticosteroids alone B. Antivirals

Answer 37

Anti-TB medications eradicate Mycobacterium tuberculosis, treating the effusion’s underlying cause.

Question 38

13. In a patient with heart failure–related effusion, which combined treatment approach is appropriate? A. Diuretics and sodium restriction D. Antibiotics and bronchodilators C. Pleurodesis only B. Steroids and hydration

Answer 38

Diuretics plus sodium restriction reduce circulating volume and venous pressure, limiting fluid buildup.

Question 39

14. What immediate nursing action should be taken if hypotension develops during thoracentesis? A. Stop procedure and assess for signs of hypovolemia D. Lower head of bed C. Continue and drain faster B. Administer diuretics

Answer 39

Stopping the procedure prevents further volume loss and allows assessment for shock.

Question 40

15. Which treatment is indicated when pleural effusion recurs frequently despite thoracentesis? A. Pleurodesis or indwelling pleural catheter D. Continuous antibiotic therapy C. Antihypertensive therapy B. Bronchodilators only

Answer 40

Pleurodesis or indwelling catheter offers long-term management to prevent repeated fluid buildup.