PCCN Questions and Answers 2023

PCCN Questions and Answers 2023 A 58-year-old male with a history of alcohol abuse is a heavy smoker. He complains of pain in his chest in the afternoons when he is sitting and watching TV. ECG shows elevation of ST segments. The most likely diagnosis is: a. Unstable angina. b. Variant/Prinzmetal's angina. c. Stable angina. d. Gastroesophageal reflux disease. B: Variant angina (also known as Prinzmetal's angina) results from spasms of the coronary arteries associated with or without atherosclerotic plaques; and is often related to smoking, alcohol, or illicit stimulants. Elevation of ST segments typically occurs with variant angina, which frequently occurs cyclically at the same time each day and often while the person is at rest. Stable angina occurs regularly with activity. Unstable angina occurs when there is a change in the pattern of stable angina. GERD pain may be mistaken for angina. Metabolic syndrome is characterized by: a. Abdominal obesity, decreased triglyceride level, increased HDL level, and hypertension. b. Hypertension, abdominal obesity, and increased HDL level. c. Abdominal obesity, increased triglyceride level, decreased HDL level, and increased fasting blood glucose level. d. Hypotension, decreased fasting blood glucose level, increased triglyceride level, and decreased HDL level. C: Metabolic syndrome (insulin resistance) puts people at risk for the development of diabetes mellitus and cardiovascular disease, and is characterized by abdominal obesity (35 inches in women and 40 inches in men), increased triglycerides (150), decreased HDL level (40 mm Hg in men and 50 mm Hg in women), elevation of blood pressure (130/ 85 mm Hg), and increased fasting glucose ( 110 mg/dL). Other indicators include elevation of C-reactive protein (evidence of a proinflammatory state) and high levels of fibrinogen (evidence of a prothrombotic state). Parenteral nutrition with a total nutrient admixture that includes lipids has been ordered for a burn patient for administration throughout a 24-hour period. When preparing to administer the solution, the nurse observes that the oil has separated, forming an obvious layer. Which of the following options is the correct action to take? a. Administer the solution, as oil separation is normal. b. Mix the solution by shaking the bag until no oil separation is noticeable. c. Discard the solution. d. Return the solution to the pharmacy for the addition of added emulsifier. C: The total nutrient admixture should be discarded if there is "cracking" of the lipid emulsion and the oil separates into a layer. With TNA, all the components of parenteral nutrition and lipids are admixed together in one container to create a 3-in-1 formula. Components of parenteral nutrition generally include proteins, carbohydrates, fats, electrolytes, vitamins, sterile water, and trace vitamins. While most postoperative patients need 1500 calories per day to prevent protein breakdown, those with fever, burns, major surgery, trauma, or hypermetabolic disease may need up to 10,000 more calories daily. A 30-year-old patient complains of post-operative pain at 8 on a 1-to-10 scale 12 hours after surgery, but is not moaning, grimacing, or exhibiting any standard physical signs of pain. The patient last received pain medication 6 hours earlier, and has orders for morphine every 4 hours as needed and ibuprofen every 6 hours as needed. Which is the most appropriate action? a. Administer ibuprofen. b. Administer morphine. c. Administer ibuprofen, and if the patient does not feel relief after one hour post-dose, then administer morphine. d. Question present family members about the patient's pain tolerance before making a decision. B: The nurse should give morphine, as 8 on a 1 to 10 scale is representative of severe pain, not uncommon in the first 24 hours after surgery. Patients have a right to pain control, and the nurse should trust that the pain is what the patient says it is. Patients may show very different behavior when they are in pain. Some may cry and moan with minor pain, and others may exhibit little difference in behavior when truly suffering. Thus, judging pain by behavior can lead to the wrong conclusions. Questioning family members is not appropriate. Q-wave myocardial infarction is characterized by: a. ST-T wave changes with ST depression that reverses within a few days. b. Small infarct size-due to spontaneous reperfusion. c. Peak CK levels in 12 to 13 hours. d. Complete coronary occlusion in 80% to 90% of patients. D: Q-wave myocardial infarction is characterized by complete coronary occlusion in 80% to 90% of patients. Abnormal Q waves (wider and deeper) are especially common in the morning. Infarction is usually prolonged, resulting in transmural necrosis. Peak CK levels occur in approximately 27 hours. Non-Q-wave myocardial infarction is characterized by ST changes with ST depression. Infarct is typically non-transmural and small with coronary occlusion in only 20% to 30% of patients. Peak CK levels occur in approximately 12 to 13 hours. A nursing team leader delegates a task to an unlicensed assistive member of the personnel. Who is responsible for patient outcomes? a. The unlicensed person who completes the task b. Both the team leader and the unlicensed person who completes the task c. The team leader who delegates the task d. The administrative staff C: The nurse who delegates remains accountable for patient outcomes and for supervision of the person to whom the task was delegated. The scope of nursing includes delegation of tasks to unlicensed assistive personnel, providing those personnel have adequate training and knowledge. Delegation can be used to manage the workload and to provide adequate and safe care. Delegation should be done in a manner that reduces liability by providing adequate communication. A patient with acute lung injury has crackling, tachypnea, and cyanosis. Oxygen therapy is instituted to maintain oxygen saturation at: a. 85% b. 90% c. 95% d. 98% B: Acute lung injury results in severely compromised lungs with crackling and wheezing, decreased pulmonary compliance, and cyanosis, so oxygen therapy is provided to maintain oxygen saturation 90%. Oxygen should be administered at 100% because of the mismatch between ventilation (V) and perfusion (Q), which can result in hypoxia upon change in positioning. Endotracheal intubation may be needed if oxygen saturation falls or carbon dioxide levels rise. The normal blood, urea, nitrogen (BUN)/creatinine ratio is: a. 5:1 b. 8:1 c. 10:1 d. 20:1 C: The normal BUN/creatinine ratio is 10:1. Normal serum creatinine is 0.6 to 1.2 mg/dL) and increases with impaired renal function, urinary tract obstruction, and nephritis. Levels should remain stable with normal functioning. Normal blood urea nitrogen (BUN) is 7 to 8 mg/dL for patients younger than age 60, and 8 to 20 mg/dL for patients 60 years of age and older. BUN increases with hypovolemia. The ratio remains normal with intrinsic kidney disease but both the BUN and creatinine levels are increased. A myocardial infarction usually causes damage to the myocardium, progressing from the endocardium to the epicardium. The first stage in myocardial damage is: a. Formation of zone of ischemia b. Formation of zone of necrosis c. Formation of zone of injury d. Decreased perfusion from hypotension A: An MI causes damage to the myocardium in stages beginning when ischemia develops, creating a zone of ischemia with viable cells. Cellular injury then occurs to those cells surrounding the infarcted area in the zone of injury. Infarction with necrosis of tissue comprises the zone of infarction, where cells are destroyed and eventually replaced with scar tissue. People may exhibit either hypertension or hypotension during an MI. A patient presents with pulmonary edema characterized by tachypnea, tachycardia, hypertension, cough, fever, and cough with frothy sanguineous sputum. What initial treatments are most common? a. Oxygen, nitroglycerine, loop diuretics (furosemide), and morphine b. Oxygen, thiazide diuretics, and ACE inhibitors c. Oxygen and thiazide diuretics d. Oxygen, morphine, and calcium channel blockers A: The most common initial treatment of acute pulmonary edema is oxygen to relieve dyspnea, nitroglycerine to reduce preload, loop diuretics, usually furosemide, to promote diuresis and venodilation, and morphine to reduce associated anxiety (although some doctors avoid morphine because of side effects). ACE inhibitors are also sometimes used to reduce afterload, but thiazide diuretics are not used to treat acute pulmonary edema. Calcium channel blockers may induce acute pulmonary edema if used with tocolytics. Acquired immunodeficiency syndrome (AIDS) is diagnosed when the following criteria are met: a. HIV infection and AIDS-defining condition, such as cytomegalovirus. b. HIV infection and CD4 count 400 cells/mm. c. HIV infection, CD4 count 100 cells/mm, and AIDS-defining condition. d. HIV infection, CD4 count 200 cells/mm, and AIDS-defining condition. D: AIDS is diagnosed with HIV infection, CD4 count 200 cells/mm, and AIDS-defining condition, such as opportunistic infections (cytomegalovirus, tuberculosis), wasting syndrome, neoplasms (Kaposi's sarcoma) or AIDS dementia complex. Patients with AIDS may present with many types of symptoms, depending on the AIDS-defining condition, but more than half exhibit fever, lymphadenopathy, pharyngitis, rash, and myalgia/arthralgia. Upon physical examination a 23-year-old female complains of chest pain and faintness upon exertion, fatigue, and loss of appetite. She has tachycardia with a weak pulse. Auscultation identifies an ejection click, a brief high-pitched sound occurring immediately after SI. Which of the following cardiac disorders is the most likely diagnosis? a. Coronary artery disease b. Mitral valve stenosis c. Pericarditis d. Aortic valve stenosis D: These symptoms, including the abnormal heart sound (ejection click), are common to aortic valve stenosis. The aortic valve controlling the flow of blood from the left ventricle narrows, causing the left ventricular wall to thicken. Aortic stenosis may result from a birth defect or from damage caused by childhood rheumatic fever. Coronary artery disease is not directly associated with abnormal heart sounds although gallop rhythms can occur with related ventricular hypertrophy. Mitral valve stenosis may cause an opening snap, while pericarditis causes a friction rub. Which of the following rhythm disturbances is most common after cardiac surgery? a. Ventricular fibrillation b. Ventricular tachycardia c. Premature ventricular contractions (PVCs) d. Atrial fibrillation, flutter, and tachycardia D: Atrial arrhythmias, including fibrillation, flutter, and tachycardia, are very common after cardiac surgery, occurring in more than half of patients with valvular surgery. Arrhythmias occur usually in the first 2-3 postoperative days and are often transient but may recur. Arrhythmias are often related to surgical manipulation. Treatment includes digoxin, blockers, calcium channel blockers, and amiodarone (often given preoperatively for 7 days to reduce incidence of postoperative arrhythmias. Electrical cardioversion may be indicated after 24 hours if sinus rhythm remains abnormal. A 64 year-old male with chronic heart failure presents with dyspnea, cough, blood-tinged frothy sputum, cyanosis, wheezing, rhonchi, and diaphoresis. He is diagnosed with pulmonary edema, placed on oxygen by mask and given morphine and IV nitrate as well as inhaled aminophylline for bronchospasm. Which of the following diuretics is the most appropriate concomitant treatment option? a. Furosemide (Lasix) b. Spironolactone (Aldactone) c. Hydrochlorothiazide (Dyazide) d. Eplerenone (Inspra) A: A short-acting intravenous loop diuretic, such as furosemide (Lasix) or bumetanide (Bumex) is indicated to rapidly reduce fluid retention and decrease pulmonary edema. Spironolactone and eplerenone are potassium-spring diuretics that have weaker diuretic actions than loop diuretics. Hydrochlorothiazide is a long-acting thiazide diuretic given as a first line treatment for hypertension rather than for acute crises. Systemic inflammatory response syndrome (SIRS) is characterized by symptoms that may include: a. Bradycardia b. Dysrhythmia c. Leukocytosis (12,000 mm) or leukopenia (4000 mm) d. PaCO 32 mm Hg C: SIRS symptoms may include leukocytosis or leukopenia. SIRS is diagnosed with 2 of the following symptoms: Leukocytosis (12,000 mm) or leukopenia (4000 mm). Elevated (38 C) or subnormal rectal temperature (36 C). Tachypnea or PaCO 32 mm Hg. Tachycardia. SIRS, a generalized inflammatory response affecting many organ systems, may be caused by infectious or noninfectious agents, such as trauma, burns, adrenal insufficiency, pulmonary embolism, and drug overdose. If an infectious agent (such as Streptococcus pneumonia or Staphylococcus aureus) is identified or suspected, SIRS may be an aspect of sepsis. A patient has been receiving heparin for 5 days and develops type I heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) with platelet count of 90,000 mm. Which of the following actions regarding heparin is most appropriate? a. Continue heparin, but monitor b. Stop heparin immediately c. Reduce dosage of heparin d. Switch to oral anticoagulants A: With type I HITTS, heparin is continued while monitoring platelet count. This condition is transient but typically resolves without intervention. Type II is an autoimmune reaction to heparin that occurs in 3% to 5% of those receiving unfractionated heparin and also occurs with low-molecular weight heparin. It is characterized by low platelets (50,000 mm) that are 50% below baseline. Onset is 5 to14 days but can occur within hours of reheparinization. Heparin-antibody complexes form and release platelet factor 4 (PF4), which attracts heparin molecules and adheres to platelets and endothelial lining; stimulating thrombin and platelet clumping. When considering the use of a translator for a patient who does not speak English which of the following considerations is of the highest importance? a. The translator has training in medical vocabulary for both languages b. The translator speaks both languages well c. The translator knows the patient's history d. The translator is available onsite A: The translator should have training in medical vocabulary for both languages because just speaking the languages well does not mean that the translator will adequately translate specialized vocabulary. It is not necessary for the translator to know the patient's history as the translator's job is only to translate what is said, not add to it or interpret it based on prior knowledge. While on-site translators are ideal, translation can be done with a speakerphone at a distance. Which of the following aneurysms would likely require immediate surgical repair? a. A dissecting 6cm aneurysm in the ascending aorta b. A 3.5cm saccular abdominal aneurysm c. A 4cm bulging thoracic aneurysm in the ascending aorta in a patient with Marfan's syndrome d. A 5cm fusiform abdominal aneurysm A: A dissecting 6-cm aneurysm in the ascending aorta is a medical emergency and requires immediate repair. Abdominal aneurysm (saccular or fusiform) repair is often delayed until it reaches 5.5 cm unless an aneurysm is rapidly expanding in size. Thoracic aneurysm repair is also typically delayed until the aneurysm reaches 5.5 cm, but those with Marfan's syndrome may be advised to have surgery at 5 cm due to increased risk. A patient with a seizure disorder falls to the floor with a generalized (grand mal) seizure. Which of the following options is the most appropriate nursing action? a. Position the patient flat on his back and loosen his clothing b. Open the jaws and insert a padded tongue blade between the teeth c. Position the patient on one side with the head flexed forward d. Do not touch the patient until the seizure subsides C: If a patient is having a generalized (grand mal) seizure, the nurse should try to position the patient on one side with the head flexed forward to allow the tongue to fall forward so that it doesn't obstruct the airway to prevent aspiration of saliva and mucus. Padding should be placed under the head to prevent injury from contact with a hard surface. The patient should not be restrained as this can cause injury. Clothing should be loosened and furniture moved out of the way. If the patient is in bed, the pillow should be removed and side rails raised. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated with: a. Hypertension b. Diabetes mellitus c. Heart failure d. Renal failure. D: ACE inhibitors are contraindicated with renal failure, as one of the most serious side effects is renal impairment, especially in patients also taking diuretics and NSAIDs. ACE inhibitors are commonly used to treat hypertension and heart failure. They are often combined with diuretics, such as thiazide for hypertension or Lasix for heart failure. ACE inhibitors are sometimes given to those with diabetes mellitus to prevent diabetic neuropathy. A 70-year-old female patient with a leg wound is being treated with negative-pressure wound therapy using a vacuum-assisted closure system. The most appropriate non-adherent porous foam for a wound that is painful and has tunneling is: a. Polyurethane (hydrophobic, repelling moisture) b. Polyvinyl (hydrophilic) c. Either polyurethane or polyvinyl d. Neither polyurethane nor polyvinyl B: Polyvinyl (hydrophilic) non-adherent porous foam is used for all wounds except deep wound with moderate granulation, deep pressure ulcers, and flaps. Polyurethane (hydrophobic, repelling moisture) is used for all wounds except those that are painful, have tunneling or sinus tracts, deep trauma wounds, and wounds needing controlled growth of granulation. The foam is cut to fit and cover the wound and is secured with foam-occlusive transparent film. An opening is cut to accommodate the drainage tube, which is attached to a suction canister, creating a closed system with pressure set to a range of 75 to 125. A patient presents with the classic signs of a myocardial infarction, including crushing chest pain, radiating to the arms and neck, palpitations, pallor, and dyspnea. The patient most likely to experience these symptoms is: a. A 60-year-old male b. A 52-year-old male with type 1 diabetes and neuropathy c. A 54-year-old female d. An 86-year-old female with Alzheimer's disease C: The 60-year-old male is most likely to experience classic signs of a myocardial infarction, as they are most common in males. Females and those under 55 often present with atypical symptoms. Diabetic patients may have reduced sensation of pain due to neuropathy and may complain primarily of weakness. Elderly patients may also have neuropathic changes that reduce sensation of pain. The Health Insurance Portability and Accountability Act (HIPAA) regulates: a. The transfer of patients from one facility to another b. Clinical trials c. Workplace safety d. The rights of the individual related to privacy of health information D: The Health Insurance Portability and Accountability Act (HIPPA) addresses the rights of the individual related to privacy of health information. The nurse must not release any information or documentation about a patient's condition or treatment without consent, as the individual has the right to determine who has access to personal information, which is considered protected health information (PHI), including health history, condition, treatments in any form, and any documentation. Personal information can be shared with spouse, legal guardians, and those with durable power of attorney. A 24-year-old female developed hepatitis after eating contaminated food in a restaurant. Which form of hepatitis does she probably have? a. Fulminant hepatitis b. Hepatitis A c. Hepatitis B d. Hepatitis C B: Hepatitis A is transmitted by the oral-fecal route, often from contamination on the hands or through sexual contact. Outbreaks have been traced to restaurants and kitchens in large facilities. Hepatitis B is transmitted through blood and body fluids, such as through sexual contact or sharing needles. Hepatitis C is transmitted directly through blood or items, such as shared needles contaminated with blood, and sexual contact. Fulminant hepatitis is an acute liver infection triggered by hepatitis or other viruses, toxins (carbon tetrachloride), Wilson's disease, and drugs, most commonly Tylenol (acetaminophen). A 48-year-old female patient has terminal ovarian cancer but states she believes her doctor has misdiagnosed her and that she wants to see a different doctor. Which stage of Elisabeth Kubler-Ross's stages of grief (death and dying) is she likely experiencing? a. Anger b. Denial c. Depression d. Bargaining D: The patient is experiencing the stage of bargaining during which patient/family may change doctors, trying to change the outcome. People grieve individually and may not go through all stages, but most go through at least 2 stages. Kubler-Ross's 5 stages of grief include: 1. Denial: Disbelieving, confused, stunned, detached, repeating questions. 2. Anger: Directed inward (self-blame) or outward. 3. Bargaining: If- then thinking. (If I go to church, then I will heal.) Trying to find a different outcome. 4. Depression: Sad, withdrawn, tearful, crying but beginning to accept loss. 5. Acceptance: Resolution and acceptance. A 76-year-old female with advanced Parkinson's disease develops cough, dyspnea, and wheezing. A chest radiograph shows infiltrates in the right lung below the right bronchus. The most likely diagnosis is: a. Foreign-body aspiration b. Pulmonary edema c. Pneumonia d. Pulmonary embolism A: The most likely diagnosis is foreign-body aspiration. Patients with advanced Parkinson's disease often have dysphagia and are prone to aspiration. Foreign body aspiration can cause obstruction of the pharynx, larynx, or trachea, leading to acute dyspnea or asphyxiation, and the object may be drawn distally into the bronchial tree. With adults, most foreign bodies migrate more readily down the right bronchus. Objects in the bronchus cause cough, dyspnea, and wheezing. A patient who experienced an episode of severe chest pain and weakness 4 days earlier is undergoing diagnostic tests. Which test would provide the most accurate information to diagnose an MI after 4 days? a. ECG b. Creatinine-kinase and isoenzyme (CK-MB) c. Myoglobin d. Troponin and its isomers (C, I, and T) D: Troponin (protein in the myocardium) and its isomers (C, I, and T) regulate contractions, and levels increases as with CK-MB after an MI, but levels remain elevated for up to three weeks. An ECG is most helpful if taken immediately after an MI so heart changes over time can be monitored. Myoglobin levels increase in 1 to 3 hours after an MI and peak within 12 hours. CK-MB levels increase within a few hours and peak at about 24-27 hours (earlier with thrombolytic therapy or PTCA) for Q-wave MI and 12-13 hours for non-Q-wave MI. A patient is admitted to the unit after vomiting excessively for 4 days at home. The patient's serum pH is elevated, PCO is relatively normal, and the urine pH is 6. The patient is dizzy, confused and is exhibiting tremors, seizures, tingling, tachycardia, arrhythmias, and hypoventilation. The patient is most likely exhibiting symptoms of: a. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis B: These symptoms are typical of metabolic alkalosis: Elevated serum pH, PCO relatively normal (if compensated) or increased (if uncompensated), and urine pH 6 (if compensated). The patient is dizzy, confused, and is exhibiting tremors, seizures, tingling, tachycardia, and arrhythmias. Metabolic alkalosis occurs with decreased strong acid or increased base, with compensatory COretention by the lungs associated with hypoventilation. Metabolic alkalosis is usually caused by excessive vomiting, gastric suctioning, diuretics, potassium deficit, excessive mineralocorticoids, and/or excessive NaHCO intake. A patient receiving chemotherapy for cancer has developed malnutrition and is receiving parenteral feedings, but the patient has developed abdominal discomfort, nausea, and diarrhea with resultant dehydration, hypotension, and tachycardia. What is the most appropriate action? a. Reduce the osmolality of the solution and then increase slowly b. Check tube placement c. Lower glucose content of solution d. Keep head of the bed elevated at all times A: The correct action is to reduce the osmolality of the solution to prevent dumping syndrome. A concentrated solution with high osmolality can draw fluid into the stomach and intestines from the surrounding tissues and the blood, causing abdominal discomfort and fullness, nausea, and diarrhea, leading to dehydration and a drop in blood pressure and increased heart rate. Patients who are weak are more prone to dumping syndrome. Reducing the osmolality and gradually increasing it allows the body to adjust and relieves symptoms. Janeway lesions, splinter hemorrhages, mucosal petechiae, and Roth's spots are most characteristic of which of the following cardiac disorders? a. Myocardial infarction b. Endocarditis c. Myocarditis d. Pericarditis B: Endocarditis is characterized by Janeway lesions (painless areas of hemorrhage on the palms of the hands and soles of the feet), splinter hemorrhages on the nails, petechiae on the oral mucosa, and Roth's spots (hemorrhagic lesions on the retina caused by emboli on nerve fibers). Other symptoms include slow onset with low-grade or intermittent fever, anorexia, weight loss, fatigue, anemia, splenomegaly, hepatomegaly, cyanosis and clubbing of fingers, CHF, heart murmur, and embolism to other body organs (brain, liver, bones). Oxygen concentration with nasal cannula delivery ranges from: a. 24% to 44% b. 50% to 64% c. 70% to 84% d. 90% to 100% A: Oxygen concentration with nasal cannula ranges from approximately 24% to 44% because it is not an airtight system; some ambient air is breathed in as well. While a nasal cannula can be used to deliver supplemental oxygen, it is only useful for flow rates6 L/min as higher rates are drying of the nasal passages. Which of the following is NOT a barrier to systems thinking? a. A holistic view of interrelationships within the organization b. Identification with role rather than purpose c. Reliance on past experience d. Feelings of victimization A: A holistic view of relationships within the organization facilitates problem-solving along with an understanding of how structures, patterns, and events affect outcomes. Those who identify with role rather than purpose may have difficulty understanding the needs of others. Those who rely too much on past experience may be resistant to change, and a feeling of victimization makes people feel that the organization or leadership is to blame for their own personal shortcomings, and they feel there is nothing they can do to make changes. Pulse oximetry is continually monitored after cardiac surgery. Arterial oxygen saturation (SPO) levels should be maintained at: a. 90% b. 92% c. 95% d. 98% C: Oxygen saturation should be maintained at 95% although some patients with chronic respiratory disorders, such as COPD may have lower SPO. Results may be compromised by impaired circulation, excessive light, poor positioning, and nail polish. If SPO falls, the oximeter should be repositioned, as incorrect positioning is a common cause of inaccurate readings. Oximetry is often used post surgically and when patients are on mechanical ventilation. An 80-year-old female presents with a small pneumothorax upon the administration of a chest radiograph, but is not in acute distress. Which of the following treatments is the most appropriate? a. Chest-tube thoracostomy with underwater seal drainage b. Immediate needle decompression and chest-tube thoracostomy c. Catheter aspiration d. Administration of oxygen at 3 to 4 L/min and observation for 3 to 6 hours and repeat chest x-ray to monitor change D: A small pneumothorax may resolve or stabilize, so the patient should receive oxygen and be observed for 3 to 6 hours. If there is no increase in size on a repeat x-ray, the patient may be discharged but asked to return for another x-ray in 24 to 48 hours. Chest-tube thoracostomy with underwater seal drainage is the most common treatment for all types of pneumothoraces. A tension pneumothorax requires immediate needle decompression followed by chest-tube thoracostomy