Ch. 30: Care of Chest Tubes (Nurs 309)

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? 1. Air will move from the lung into the pleural space. 2. The heart and great vessels shift toward the affected side. 3. There is greater negative pressure within the chest cavity. 4. Collapse of the other lung will occur if not treated immediately.

1. Air will move from the lung into the pleural space.

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? 1. Observe for fluid fluctuations in the water-seal chamber. 2. Obtain a prescription for morphine to minimize agitation. 3. Apply a thoracic binder to prevent excessive tension on the tube. 4. Clamp the tubing securely to prevent a rapid decline in pressure.

1. Observe for fluid fluctuations in the water-seal chamber.

How should the nurse monitor for the complication of subcutaneous emphysema after the insertion of chest tubes? 1. Palpate around the tube insertion sites for crepitus. 2. Auscultate the breath sounds for crackles and rhonchi. 3. Observe the client for the presence of barrel-shaped chest. 4. Compare the length of inspiration with the length of expiration.

1. Palpate around the tube insertion sites for crepitus.

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? 1. Remove the air that is present in the intrapleural space. 2. Drain serosanguinous fluid from the intrapleural compartment. 3. Permit the development of positive pressure between the layers of the pleura. 4. Provide access for the instillation of medication into the pleural space.

1. Remove the air that is present in the intrapleural space.

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? 1. Chest tube drainage of 10 to 15 mL/hr. 2. Continuous bubbling in the water seal chamber. 3. Reports of chest pain at the chest tube site. 4. Chest tube dressing dated yesterday.

2. Continuous bubbling in the water seal chamber.

A client has chest tubes attached to a chest-tube drainage system. What should the nurse do when caring for this client? 1. Clamp the chest tubes when suctioning. 2. Palpate the surrounding area for crepitus. 3. Change the dressing daily using aseptic technique. 4. Empty the drainage chamber at the end of the shift.

2. Palpate the surrounding area for crepitus.

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply. 1. Hematemesis 2. Shortness of breath 3. Unilateral chest pain 4. Increased thoracic motion 5. Mediastinal shift toward the involved side.

2. Shortness of breath 3. Unilateral chest pain

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? 1. Rupture of the pericardium. 2. Infection of the subpleural lining. 3. Decreased filling of the right heart. 4. Increased volume of the unaffected lung.

3. Decreased filling of the right heart.

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? 1. Pleural friction rub. 2. Tracheoesophageal fistula. 3. Rupture of a subpleural bleb. 4. Puncture wound of the chest wall.

3. Rupture of a subpleural bleb.

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? 1. Take the client's vital signs. 2. Inform the health care provider. 3. Turn the client to the unaffected side. 4. Check the tube to ensure that it is not kinked.

4. Check the tube to ensure that it is not kinked.

A client has a pneumothorax, and a closed-chest drainage system is inserted to allow the lung to reinflate. Identify the chamber in the figure below that provides the water seal. (Pg. 271 NCLEX-RN). 1. A 2. B 3. C 4. D

The dark red chamber. 3. C

A client who was involved in a motor vehicle collision sustained multiple internal injuries, and thoracic surgery was performed. After the surgery the client has two chest tubes attached closed chest drainage systems. Place an X on the image on the right where the nurse should palpate to identify where the complication of subcutaneous emphysema most likely may occur.

Upper most insertion site, along the skin is where the nurse should palpate.