Chest Tubes

A chest tube is inserted into a client who was stabbed in the chest and is attached to a closed-drainage system. Which is an important nursing intervention when caring for this client? A. Observe for fluid fluctuations in the water-seal chamber. B. Obtain a prescription for morphine to minimize agitation. C. Apply a thoracic binder to prevent excessive tension on the tube. D. Clamp the tubing securely to prevent a rapid decline in pressure.

A

A client has been admitted with chest trauma after a motor vehicle crash and has undergone subsequent intubation. The nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breath sounds in the right upper lobe of the lung. The nurse immediately assesses for other signs of which condition? A. Right pneumothorax B. Pulmonary embolism C. Displaced endotracheal tube D. Acute respiratory distress syndrome

A

A client is diagnosed with a spontaneous pneumothorax. Which physiological effect of a spontaneous pneumothorax should the nurse include in a teaching plan for the client? A. Air will move from the lung into the pleural space. B. The heart and great vessels shift toward the affected side. C. There is greater negative pressure within the chest cavity. D. Collapse of the other lung will occur if not treated immediately.

A

A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish? A. Remove the air that is present in the intrapleural space. B. Drain serosanguinous fluid from the intrapleural compartment. C. Permit the development of positive pressure between the layers of the pleura. D. Provide access for the instillation of medication into the pleural space.

A

A patient with a gunshot wound to the right side of the chest arrives in the emergency department exhibiting severe shortness of breath with decreased breath sounds on the right side of the chest. Which action should the nurse take immediately? a. Cover the chest wound with a nonporous dressing taped on three sides. b. Pack the chest wound with sterile saline soaked gauze and tape securely. c. Stabilize the chest wall with tape and initiate positive pressure ventilation. d. Apply a pressure dressing over the wound to prevent excessive loss of blood.

A

How should the nurse monitor for the complication of subcutaneous emphysema after the insertion of chest tubes? A. Palpate around the tube insertion sites for crepitus. B. Auscultate the breath sounds for crackles and rhonchi. C. Observe the client for the presence of barrel-shaped chest. D. Compare the length of inspiration with the length of expiration.

A

​​The nurse notes tidaling of the water level in the tube submerged in the water-seal chamber in a patient with closed chest tube drainage. The nurse should a. continue to monitor the patient. b. check all connections for a leak in the system. c. lower the drainage collector further from the chest. d. clamp the tubing at progressively distal points away from the patient until the tidaling stops.

A

The nurse is admitting a patient with a diagnosis of pulmonary embolism. What risk factors is a priority for the nurse to assess (select all that apply.)? Select all that apply. a. Obesity b. Pneumonia c. Malignancy d. Cigarette smoking e. Prolonged air travel

A, C, D, E

The nurse assesses a client with a diagnosis of rib fractures to identify the risk for potential complications. The nurse notes that the client has a history of emphysema. After the assessment, the nurse ensures that which interventions are documented in the plan of care? Select all that apply. A. Maintain the client in a position of comfort. B. Collect sputum specimens at the hour of sleep. C. Offer medication to suppress the cough as needed. D. Administer small, frequent meals with plenty of fluids. E. Have the client cough and breathe deeply 20 minutes after pain medication is given. F. Administer 4 to 6 liters of oxygen when the client's pulse oximetry drops below 90%.

A, D, E

A client has chest tubes attached to a chest-tube drainage system. What should the nurse do when caring for this client? A. Clamp the chest tubes when suctioning. B. Palpate the surrounding area for crepitus. C. Change the dressing daily using aseptic technique. D. Empty the drainage chamber at the end of the shift.

B

A patient who has a right-sided chest tube after a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is appropriate? A. Adjust the dial on the wall regulator. B. Continue to monitor the collection device. C. Document the presence of a large air leak. D. Notify the surgeon of a possible pneumothorax.

B

The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding would indicate the presence of a pneumothorax in this client? A. A low respiratory rate B. Diminished breath sounds C. The presence of a barrel chest D. A sucking sound at the site of injury

B

The nurse instructs a patient with a pulmonary embolism about administering enoxaparin after discharge. Which statement by the patient indicates understanding about the instructions? a. "I need to take this medicine with meals." b. "The medicine will be prescribed for 10 days." c. "I will inject this medicine into my upper arm." d. "The medicine will dissolve the clot in my lung."

B

The nurse is caring for a patient with a tracheostomy tube. Which nursing intervention is most effective in promoting effective airway clearance? a. Suctioning respiratory secretions several times every hour b. Administering humidified oxygen through a tracheostomy collar c. Instilling normal saline into the tracheostomy to thin secretions before suctioning d. Deflating the tracheostomy cuff before allowing the patient to cough up secretions

B

The nurse is evaluating and assessing a patient with a diagnosis of chronic emphysema. The patient is receiving oxygen at a flow rate of 5 L/min by nasal cannula. Which finding concerns the nurse immediately? A. Fine bibasilar crackles B. Respiratory rate of 8 breaths/min C. The patient sitting up and leaning over the nightstand D. A large barrel chest

B

The nurse is suctioning a patient with a tracheostomy tube. Which action will the nurse take? a. Set suction regulator at 150 to 200 mm Hg. b. Limit the length of suctioning to 10 seconds. c. Apply suction while gently rotating and inserting the catheter. d. Liberally lubricate the end of the suction catheter with a water-soluble solution.

B

The nurse is supervising a nursing student who is providing care for a thoracotomy patient with a chest tube. What finding would the nurse clearly instruct the nursing student to report immediately? A. Chest tube drainage of 10 to 15 mL/hr. B. Continuous bubbling in the water seal chamber. C. Reports of chest pain at the chest tube site. D. Chest tube dressing dated yesterday.

B

To determine whether a tension pneumothorax is developing in a patient with chest trauma, for what does the nurse assess the patient? a. Dull percussion sounds on the injured side b. Severe respiratory distress and tracheal deviation c. Muffled and distant heart sounds with decreasing blood pressure d. Decreased movement and diminished breath sounds on the affected side

B

When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes a. maintaining the patient on bed rest. b. using sequential compression devices. c. encouraging the patient to cough and deep breathe. d. teaching the patient how to use the incentive spirometer.

B

While the nurse is changing the ties on a tracheostomy collar, the patient coughs, dislodging the tracheostomy tube. Which action will the nurse take first? a. Press the emergency response button. b. Insert a spare tracheostomy with the obturator. c. Manually occlude the tracheostomy with sterile gauze. d. Place a face mask delivering 100% oxygen over the nose and mouth.

B

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply. A. Hematemesis B. Shortness of breath C. Unilateral chest pain D. Increased thoracic motion E. Mediastinal shift toward the involved side.

B, C

A client with emphysema experiences a sudden episode of shortness of breath and is diagnosed with spontaneous pneumothorax. The client asks, "how could this have happened?" What likely cause of the spontaneous pneumothorax should the nurse's response take into consideration? A. Pleural friction rub. B. Tracheoesophageal fistula. C. Rupture of a subpleural bleb. D. Puncture wound of the chest wall.

C

A patient with a pneumothorax has a chest tube inserted and is placed on low constant suction. Which finding requires immediate action by the nurse? a. The patient reports pain at the chest tube insertion site that increases with movement. b. Fifty milliliters of blood gushes into the drainage device after the patient coughs. c. No bubbling is present in the suction control chamber of the drainage device. d. Yellow purulent discharge is seen leaking out from around the dressing site.

C

Following a pneumonectomy, an appropriate nursing intervention is a. monitoring chest tube drainage and functioning. b. position the patient on the unaffected side or back. C. doing range-of-motion exercises on the affected upper limb. d. auscultating frequently for lung sounds on the affected side.

C

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions? a. Water-seal chamber has 5 cm of water. b. No new drainage in collection chamber c. Chest tube with a loose-fitting dressing d. Small pneumothorax at CT insertion site

C

The nurse has just auscultated coarse crackles bilaterally on a patient with a tracheostomy tube in place. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. B. Encourage the patient to increase oral fluid intake. C. Put on sterile gloves and use a sterile catheter to suction. D. Preoxygenate the patient for 3 minutes before suctioning.

C

The nurse is caring for a patient with emphysema and respiratory failure who is receiving mechanical ventilation through an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care? A.) Administer ordered antibiotics as scheduled. B.) Hyperoxygenate the patient before suctioning. C.) Maintain the head of bed at a 30- to 45-degree angle. D.) Suction the airway when coarse crackles are audible.

C

The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. Which assessment finding is of most concern? A. A large air leak in the water-seal chamber B. Report of pain with each deep inspiration C. 400 mL of blood in the collection chamber D. Subcutaneous emphysema at the insertion site

C

When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such a shift occurs, what potential effect is a cause for concern? A. Rupture of the pericardium. B. Infection of the subpleural lining. C. Decreased filling of the right heart. D. Increased volume of the unaffected lung.

C

A 15-year-old is diagnosed with restrictive lung disease caused by fibrosis. Which pulmonary function test finding is expected? a. Increased compliance b. Increased tidal volume c. Decreased respiratory rate d. Decreased functional residual capacity

D

A 70-year-old hospitalized for a pelvic fracture develops a pulmonary embolism. The nurse realizes this embolus is most commonly composed of: a. fat. b. air. c. tissue fragment. d. blood clot.

D

During the first 36 hours after the insertion of chest tubes, when assessing the function of a three-chamber, closed-chest drainage system, the nurse identifies that the water in the underwater seal tube is not fluctuating. What initial action should the nurse take? A. Take the client's vital signs. B. Inform the health care provider. C. Turn the client to the unaffected side. D. Check the tube to ensure that it is not kinked.

D

The emergency department nurse notes tachycardia and absent breath sounds over the right thorax of a patient who has just arrived after an automobile accident. For which intervention will the nurse prepare the patient? A. Emergency pericardiocentesis B. Stabilization of the chest wall C. Bronchodilator administration D. Chest tube connected to suction

D

The nurse is assessing a patient with emphysema. Which assessment finding requires further follow-up with the health care provider? A. Increased anterior-posterior diameter of the chest B. Accessory muscle used for breathing C. Clubbing of the fingers D. Hemoptysis

D

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? A. Sitting up in bed B. Side-lying in bed C. Sitting in a recliner chair D. Sitting on the side of the bed and leaning on an overbed table

D