Chest Tubes & Chest Trauma

A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to a water-seal chest tube drainage system. The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation? 1. An obstruction is present in the chest tube. 2. The client is developing subcutaneous emphysema. 3. The chest tube system is functioning properly. 4. There is a leak in the chest tube system.

3. The chest tube system is functioning properly.

A client who underwent a lobectomy and has a water seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client's pulse rate has also increased. What should the nurse do next? 1. Check the tubing to ensure that the client is not lying on it or kinking it. 2. Increase the suction 3. Lower the drainage bottles 2-3 feet below the level of the client's chest. 4. Ensure that the chest tube has two clamps on it to prevent air leaks.

1. Check the tubing to ensure that the client is not lying on it or kinking it.

A client has a chest tube attached to a water seal drainage system, and the nurse notes that the fluid in the chest tube and in the water seal column has stopped fluctuating. How should the nurse interpret this finding? 1. The lung has fully expanded 2. The lung has fully collapsed 3. The chest tube is in the pleural space 4. The mediastinal space has decreased

1. The lung has fully expanded

When assess a client with chest trauma, the nurse notes that the client is taking small breaths at first, then bigger breaths, and then a couple small breasts, then 10 to 20 seconds of no breathes. How should the nurse record the breathing pattern. 1. cheyne-stokes respirations 2. hyperventilation 3. obstructive sleep apnea 4. biot's respirations

1. cheyne-stokes respirations

When teaching a client to deep breathe effectively after a lobectomy, what should the nurse instruct the client to do? 1. contract the abdominal muscles; take a slow deep breath through the nose, hold it for 3 to 5 seconds and then exhale. 2. Contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle. 3. Relax the abdominal muscles, take a slow deep breath through the nose, and hold it for 3-5 seconds. 4. Relax the abdominal muscles, take a deep breath through the mouth, and exhale slowly over 10 seconds.

1. contract the abdominal muscles; take a slow deep breath through the nose, hold it for 3 to 5 seconds and then exhale.

For a client with rib fracture and a pneumothorax, the HCP prescribes morphine sulphate, 1 - 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which finding indicates that the goal has been met? 1. pain rating of 0-2 on a scale of 0-10 by the client. 2. decreased client anxiety 3. respiratory rate of 26 breaths per minute 4. PaO2 of 70 mm Hg

1. pain rating of 0-2 on a scale of 0-10 by the client.

A client is undergoing a thoracentesis. What should the nurse monitor the client for during and immediately after the procedure? Select all that apply. 1. pneumothorax 2. subcutaneous emphysema 3. tension pneumothorax 4. pulmonary edema 5. infection

1. pneumothorax 2. subcutaneous emphysema 3. tension pneumothorax 4. pulmonary edema

A client has been in an automobile accident, and the nurse is assessing the client for possible pneumothorax. What finding should the nurse immediately report to the HCP? 1. sudden, sharp chest pain 2. wheezing breath sounds over affected side 3. hemoptysis 4. cyanosis

1. sudden, sharp chest pain S&S of a pneumothorax includes - sudden, sharp chest pain, tachypnea, and tachycardia.

A client with COPD has a signed living will with a DNR request. While the wife was visiting the client, he had a cardiac arrest. The wife requested the client be resuscitated immediately. When the nurse hesitated to start resuscitation procedures the wife threatened to sue the hospital. What should the nurse do? Select all that apply. 1. Call the code for fear of being sued by the wife. 2. Carry out the written DNR request and client wishes 3. Calmly remind the wife of the client's wishes and DNR request. 4. Notify the nurse manager of the situation 5. Call the chaplain to come and remain with the wife. 6. Notify the HCP

2. Carry out the written DNR request and client wishes 3. Calmly remind the wife of the client's wishes and DNR request. 4. Notify the nurse manager of the situation 5. Call the chaplain to come and remain with the wife. 6. Notify the HCP

The nurse observes a constant gentle bubbling in the water seal column of a water chest tube drainage system. What should the nurse do next? 1. Continue monitoring as usual; this is expected. 2. Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system. 3. Decrease the suction and continue observing the system for changes i bubbling during the next several hours. 4. Notify the health care provider.

2. Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system.

A young adult is admitted to the emergency department after an automobile accident. The client has severe pain in the right chest from contact with the steering wheel. What should the nurse do first? 1. Reduce the client's anxiety 2. Maintain adequate oxygenation 3. Decrease chest pain 3. Maintain adequate circulating volume

2. Maintain adequate oxygenation

Following a thoracotomy, the client has pain of 9 on a 10-point scale. What should the nurse do thirty minutes after administering the highest dose of the prescribed pain medication? 1. Reposition the client 2. Reassess the client 3. Reassure the client 4. Readjust the pain medication dosage as needed

2. Reassess the client

The nurse has received a change of shift report on clients. Which client should the nurse assess first? 1. a client with COPD with a PaO2 of 56 mm Hg who is being discharged home on oxygen. 2. a client with asthma with respirations of 36 breaths per minute whose wheezing has diminished 3. a client with asthma who has a heart rate of 90 ppm and whose beta-blocker is scheduled to be administered now. 4. a client who is scheduled for an angiogram now and is ready to be transported

2. a client with asthma with respirations of 36 breaths per minute whose wheezing has diminished

A nurse has received report on four clients. Which client would the nurse visit first? 1. a client with congestive heart failure, who has gained 2 pounds overnight. 2. a client with tuberculosis who raised 50 mL of sanguineous sputum of the past 2 hours 3. a client with C.difficile who continues to have loose, foul smelling stools. 4. a client with COPD whose last report of oxygen saturation was 91%.

2. a client with tuberculosis who raised 50 mL of sanguineous sputum of the past 2 hours

The nurse is preparing to assist with the removal of a chest tube. Which dressing is appropriate at the sire from which the chest tube is removed? 1. adhesive strips 2. petrolatum gauze 3. dry 4x4 gauze 4. no dressing necessary

2. petrolatum gauze (makes an air-tight seal)

While assessing a thoracotomy incisional area from which a chest tube exits, the nurse feels a crackling sensation under the fingertips along the entire incision. What should the nurse do NEXT? 1. lower the head of the bed, and call the HCP 2. prepare and aspiration tray 3. mark the area with a skin pencil at the outer periphery of the crackling 4. Turn off the suction of the chest drainage system

3. mark the area with a skin pencil at the outer periphery of the crackling

A nurse should interpret which finding as an early sign of a tension pneumothorax in a client with chest trauma? 1. diminished bilateral breath sounds 2. muffled heart sounds 3. respiratory distress 4. tracheal deviation

3. respiratory distress

The nurse is assessing a client who has a chest tube connected to a water seal chest tube drainage system. According to the illustration shown, what should the nurse do? 1. clamp the chest tube near the insertion site to prevent air from entering the pleural cavity. 2. Notify the health care provider of the amount of chest tube drainage. 3. Add water to maintain the water seal. 4. Lower the drainage system to maintain gravity flow.

4. Lower the drainage system to maintain gravity flow.

A client has a chest tube and water seal drainage system. What should the nurse do to ensure safe and effective use of the drainage system? 1. Verify that the air vent on the water seal drainage system is capped when the suction is off. 2. Strip the chest drainage tubes at least every 4 hours if excessive bleeding occurs. 3. Ensure that the chest tube is clamped when moving the client out of the bed. 4. Make sure that the drainage apparatus is always below the client's chest level.

4. Make sure that the drainage apparatus is always below the client's chest level.

After a thoracotomy, the nurse instructs the client to perform deep-breathing exercises. What is an expected outcome of these exercises? 1. The elevated diaphragm enlarges the thorax and increases the lung surface available for gas exchange. 2. There is increased blood flow to the lungs to allow them to recover from the trauma of surgery. 3. The rate of airflow to the remaining lobe is controlled so that it will not become hyper inflated. 4. The alveoli expand and increase the lung surface available for ventilation.

4. The alveoli expand and increase the lung surface available for ventilation.