ATI Skills Module 3.0: Closed-Chest Drainage Test

A nurse is caring for a client who has a chest tube in place that is attached to water-seal drainage system. Which of the following findings should the nurse recognize as an indication of subcutaneous emphysema?

A dry, crackling sound at the insertion site when palpated Reasoning: A dry, crackling sound at the insertion site is an indication of subcutaneous emphysema, which is a result of air leaking into the subcutaneous tissue surrounding the chest-tube insertion site.

A nurse is assessing a client 5 hr after the insertion of a chest tube that is attached to a water-seal drainage system. Which of the following observations about the drainage should the nurse report to the provider?

About 150 mL/hr drainage over the past 2 hr Reasoning: After the first few hours, the nurse should report drainage that exceeds 70 mL/hr. Clients who lose 100 mL of blood every 15 min might require autotransfusion within 6 hr.

A nurse is planning education for a client who has a chest tube in place that is attached to a closed-chest drainage system. Which of the following instructions should the nurse plan to provide when the client is ready to ambulate?

Keep the collection device upright at all times Reasoning: The closed-chest drainage system must be kept upright at all times to ensure that the tubing drains optimally and the system functions correctly.

A nurse is preparing to transport a client who has a chest tube and a closed-chest wet-suction drainage system to radiology. Which of the following actions should the nurse take when detaching the suction source for transportation?

Make sure the air vent is open Reasoning: Some closed-chest drainage systems and suction devices contain a vent from the water-seal chamber. This allows the drainage unit to remain vented without suction So, the nurse should make sure this exit vent is open when disconnecting the suction source.

A nurse is caring for a client who has a chest tube in place that is attached to a closed-chest drainage system. Which of the following actions should the nurse take if the chest tube becomes dislodged from the closed-chest drainage system?

Submerge the end of the chest tube in 1 inch of sterile water Reasoning: This action creates a water seal and prevents air from entering the pleural space through the open end of the chest tube when the client inhales.

A nurse is caring for a client who is 6 hr postoperative and has a chest tube in place that is attached to a closed-chest water-seal drainage system. The nurse should identify that which of the following is an indication of a problem in the drainage system?

Continuous bubbling in the water-seal chamber Reasoning: Excessive and continuous bubbling in the water-seal chamber indicated an air leak in the drainage system. The nurse should use rubber-tipped clamps to try to locate the leak by clamping the tube momentarily near the site of the chest tube insertion.

A nurse is caring for a client who has a chest tube in place. Which of the following strategies should the nurse use to help promote comfort for the client?

Have the client splint the affected side during coughing Reasoning: It is essential for a client with a chest tube to cough to prevent postoperative complications and to help drain the pleural space and expand the lungs. Splinting the affected side, such as with a pillow, can help minimize the pain of coughing. The nurse should also administer analgesia to help reduce the pain of coughing and other activities.

A nurse is caring for a client who requires a chest tube. The provider asks for the suction pressure of the closed-chest drainage system to be set at -40cm of water. Which of the following closed-chest drainage systems should the nurse prepare for this client?

Dry suction-control system Reasoning: Systems that use dry-suction control allow for higher suction pressures by adjusting a dial on the front surface of the system to deliver suction pressure up to -40cm of water. Some clients need high suction pressures due to a massive air leak from the lung surface, emphysema or viscous pleural effusion, or a reduction in pulmonary compliance.