Oxygenation & Circulation - Chest Tube Drainage System

Question 1

Oxygenation & Circulation - Chest Tube Drainage System

Where should the drainage system of a chest tube always be kept?

Answer 1

Below the level of the client’s chest on the affected side.

Question 2

Oxygenation & Circulation - Chest Tube Drainage System

How often should the nurse assess the dressing site of a chest tube insertion?

Answer 2

q4h

Question 3

Oxygenation & Circulation - Chest Tube Drainage System

What are signs of subcutaneous emphysema in a chest tube drainage system?

Answer 3

Crackling sound upon ausculatation.

Question 4

Oxygenation & Circulation - Chest Tube Drainage System

What is subcutaneous emphysema? What is it an indication of in a chest tube drainage system?

Answer 4

Air in the subcutaneous tissues. It is an indication of a poor seal at the chest tube insertion site.

Question 5

Oxygenation & Circulation - Chest Tube Drainage System

How often should the client with a chest tube drainage system perform deep breathing and coughing exercises?

Answer 5

q2h. Unless the client has had a lung removed.

Question 6

Oxygenation & Circulation - Chest Tube Drainage System

Is fluctuating water seal level in a chest tube drainage system a normal or abnormal finding?

Answer 6

This is a normal finding. Water seal level should fluctuate with respiratory effort.

Question 7

Oxygenation & Circulation - Chest Tube Drainage System

When is the drainage chamber of a chest tube drainage system replaced?

Answer 7

When it is almost full.

Question 8

Oxygenation & Circulation - Chest Tube Drainage System

Is it recommended to “milk” or “strip” the chest tube to manipulate it?

Answer 8

No. Aggressive chest tube manipulations should be avoided. Studies have shown this does not improve chest tube patency.

Question 9

Oxygenation & Circulation - Chest Tube Drainage System

What should the nurse do if the tube becomes disconnected from the collecting system?

Answer 9

The nurse should submerge the end in 1 inch of sterile saline water to maintain the seal.

Question 10

Oxygenation & Circulation - Chest Tube Drainage System

What should the nurse do if the chest tube is inadvertently pulled out?

Answer 10

The nurse should immediately cover the wound with dry sterile dressing.

NOTE: if air is heard leaking out of the site, ensure the dressing is NOT occlusive. If the air cannot escape, this would lead to a tension pneumothorax (air in the pleural sac)

Question 11

Oxygenation & Circulation - Chest Tube Drainage System

How should the nurse transport or ambulate a client with a chest tube drainage system?

Answer 11

The nurse should disconnect the drainage system from the suction apparatus before moving the client and make sure the air vent is open.

Question 12

Oxygenation & Circulation - Berman Book (Chapter 35)

While a client with chest tubes is ambulating, the connection between the tube and the water seal dislodges. Which of the following actions by the nurse is most appropriate?

A. Assist the client to ambulate back to bed.
B. Reconnect the tube to the water seal.
C. Assess the client’s lung sounds with a stethoscope.
D. Have the client cough forcibly several times.

Answer 12

B. Reconnect the tube to the water seal.

Rationale:
The tube should be reconnected to the water seal as quickly as possible. Assisting the client back to bed and assessing the client’s lungs are possible actions after the system is reconnected, but these should not be performed until the tube is reconnected to the water seal. Coughing forcibly is not appropriate.

Question 13

Oxygenation & Circulation - Berman Workbook (Chapter 35)

Which of the following devices can attach to the chest tube and has a one-way valve and a small built-in collection chamber?

A. Pneumostat
B. Heimlich valve
C. Suction catheter
D. Ventilator

Answer 13

A. Pneumostat

Rationale:
This is used exclusively for clients with a pneumothorax who usually have small amounts of fluids.

Question 14

Oxygenation & Circulation - Saunders NCLEX-PN Review (Ch. 19)

184. A nurse is assigned to assist with caring for a client who has a chest tube. The nurse notes fluctuations of the fluid level in the water-seal chamber. Based on this observation, which action would be appropriate?

A. Empty the drainage.
B. Encourage the client to deep breathe.
C. Continue to monitor, because this is an expected finding.
D. Encourage the client to hold his or her breath periodically.

Answer 14

C. Continue to monitor, because this is an expected finding.

Rationale:
The presence of fluctuations in the fluid level in the water-seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspirations and falls with expiration. The apparatus and all connections must remain airtight at all times, and the drainage is never emptied. Encouraging the client to deep breathe is unrelated to this observation. The client is not to hold his or her breath.

Test-Taking Strategy:
Focus on the subject of the question — “…the fluctuation of the fluid level in the water-seal chamber;” this will assist you with eliminating options A, B, and D.

Question 15

Oxygenation & Circulation - Saunders NCLEX-PN Review (Ch. 19)

185. A nurse is assigned to assist the physician with the removal of a chest tube. The nurse instructs the client to do which of the following during this process?

A. Stay very still.
B. Exhale slowly.
C. Inhale and exhale quickly.
D. Perform Valsalva’s maneuver.

Answer 15

D. Perform Valsalva’s maneuver.

Rationale:
When the chest tube is removed, the client is asked to perform Valsalva’s maneuver (i.e., take a deep breath, exhale, and bear down), the tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative instruction is to ask the client to take a deep breath and hold the breath while the tube is removed. Options A, B, and C are incorrect client instructions.

Test-Taking Strategy:
Use the process of elimination. Visualize the procedure and the client instructions given in each option as you answer the question; this will direct you to option D.

Question 16

Oxygenation & Circulation - Saunders NCLEX-PN Review (Ch. 19)

188. The nurse is assisting in caring for a client with a chest tube. The nurse understands that which f the following is an incorrect action for the care of the client?

A. Pin the tubing to the bedclothes.
B. Be sure all connections are taped.
C. Be sure all connections remain airtight.
D. Do not allow the tubing to become kinked or obstructed by the weight of the client.

Answer 16

A. Pin the tubing to the bedclothes.

Rationale:
Chest tubing is never pinned to the bedclothes, because this presents the risk of accidental dislodgment of the tube when the client moves. Options A, B, and C are appropriate interventions for the plan of care for a client with a chest tube.

Question 17

Oxygenation & Circulation - Saunders NCLEX-PN Review (Ch. 19)

189. A nurse is assigned to care for a client who has a chest tube. The nurse is told to monitor the client for subcutaneous emphysema. The nurse monitors the client for this complication by:

A. Monitoring for pain.
B. Monitoring respirations hourly.
C. Checking the BP q2h.
D. Palpating for the leakage of air into the subcutaneous tissues.

Answer 17

D. Palpating for the leakage of air into the subcutaneous tissues.

Rationale:
Subcutaneous emphysema is also known as crepitus. It presents as a “puffed-up” appearance that is caused by the leakage of air into the subcutaneous tissues. It is monitored by palpating, and it feels like bubble wrap when palpated. Although options A, B, and C may be components of the plan of care for a client with a chest tube, these actions will not identify subcutaneous emphysema.

Question 18

Oxygenation & Circulation - Saunders NCLEX-PN Review (Ch. 19)

191. A nurse is assisting with monitoring the functioning of a chest-tube drainage system in a client who just returned from the recovery room after a thoracotomy with wedge resection. Which findings would the nurse expect to note? Select all that apply.

A. Excessive bubbling in the water-seal chamber.
B. Vigorous bubbling in the suction-control chamber.
C. 50 mL of drainage in the drainage-collection chamber.
D. The drainage system is maintained below the client’s chest.
E. An occlusive dressing is in place over the chest-tube insertion site.
F. Fluctuation of water in the tube of the water-seal chamber during inhalation and exhalation.

Answer 18

C. 50 mL of drainage in the drainage-collection chamber.
D. The drainage system is maintained below the client’s chest.
E. An occlusive dressing is in place over the chest-tube insertion site.
F. Fluctuation of water in the tube of the water-seal chamber during inhalation and exhalation.

Rationale:
Excessive bubbling in the water-seal chamber may indicate an air leak, which is an unexpected finding. Gentle (not vigorous) fluctuation bubbling should be noted in the suction-control chamber.

Question 19

Oxygenation & Circulation - Burke Textbook (Chapter 23)

A client with a chest tube trips while ambulating, accidentally pulling his chest tube out of the chest. The first thing the nurse should do is:

A. Call the physician.
B. Place an occlusive dressing over the wound.
C. Reinsert the tube.
D. Empty the collection device.

Answer 19

B. Place an occlusive dressing over the wound.

Rationale:
The wound is covered with an occlusive dressing to prevent air from entering the pleural space, then the physician is notified. Reinsertion of the tube introduces bacteria and other possible contaminants into the pleural space.

Question 20

Oxygenation & Circulation - Burke Textbook (Chapter 23)

You are assessing the chest tube for a client with lungcancer. You notice that the water in the water seal is fluctuating with the client’s breathing. Your next action should be to:

A. Continue with the assessment.
B. Call the physician after your assessment.
C. Ask the client if he feels okay.
D. Shake the water chamber to stop the bubbling.

Answer 20

A. Continue with the assessment.