NCLEX Questions- Care of a Client with a tube, Chest Tube questions, CHEST TUBE questions

The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is most appropriate? 1. Do nothing, because this is an expected finding 2. Check for an air leak because the bubbling should be intermittent 3. Increase the suction pressure so that the bubbling becomes vigorous 4. Immediately clamp the chest tube and notify the health care provider

1. Rationale-Continuous gentle bubbling should be noted in the suction control chamber. Bubbling should be continuous in the suction control chamber and not intermittent. Increasing the suction pressure only increased the rate of evaporation of water in the drainage system; in addition, increasing the suction can be harmful and is not done without a specific prescription to do so. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy).

The nurse is caring for a client immediately after removal of the endotracheal tube. The nurse should report which sign immediately if experienced by the client? 1. Stridor 2. Occasional pink-tinged sputum 3. Respiratory rate of 24 breaths/minute 4. A few basilar lung crackles on the right

1. Rationale-Following removal of the endotracheal tube the nurse monitors the client for respiratory distress. The nurse reports stridor to the health care provider (HCP) immediately. This is a high-pitched, coarse sound that is heard with the stethoscope over the trachea. Stridor indicates airway edema and places the client at risk for airway obstruction. Although the findings identified in the remaining options require monitoring, they do not require immediate notification of the health care provider.

The nurse caring for a client with a chest tube turns the client to the side and the chest tube accidentally disconnects from the water seal chamber. Which initial nursing action should the nurse take? 1. Call the health care provider 2. Place the tube in a bottle of sterile water 3. Immediately replace the chest tube system 4. Place a sterile dressing over the disconnection site

2. Rationale-If the chest drainage system is disconnected, the end of the tube is placed in a bottle of sterile water held below the level of the chest. The HCP may need to be notified, but this is not the initial action. The system is replaced if it breaks or cracks or if the collection chamber is full. Placing a sterile dressing over the disconnection site will not prevent complications resulting from the disconnection.

While changing the tapes on a tracheotomy tube, the client coughs and the tube is dislodged. Which is the initial nursing action? 1. Call the health care provider to reinsert the tube. 2. Grasp the retention sutures to spread the opening 3. Call the respiratory therapy department to reinsert the tracheotomy. 4. Cover the tracheostomy site with a sterile dressing to prevent infection.

2. Rationale-If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures and spread the opening. If agency policy permits, the nurse then attempts immediately to replace the tube. Calling ancillary services or the HCP will delay treatment in this emergency situation. Covering the tracheostomy sire will block the airway.

The nurse is assessing the functioning of a chest tube drainage system in a client who has just returned from the recovery room following a thoracotomy with wedge resection. Which are the expected assessment findings? Select all that apply. 1. Excessive bubbling in the water seal chamber 2. Vigorous bubbling in the suction control chamber 3. Drainage system maintained below the client's chest 4. 50 mL of drainage in the drainage collection chamber 5. Occlusive dressing in place over the chest tube insertion site 6. Fluctuation of water in the tube in the water seal chamber during inhalation and exhlation

3,4,5, and 6. Rationale-The bubbling of water in the water seal chamber indicates air drainage from the client and usually is seen when intrathoracic pressure is higher than atmospheric pressure, and may occur during exhalation, coughing, or sneezing. Excessive bubbling in the water seal chamber may indicate an air leak, an unexpected finding. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation is expected. An absence of fluctuation may indicate that the chest tube is obstructed or that the lung has reexpanded and that no more air is leaking into the pleural space. Gentle (not vigorous) bubbling should be noted in the suction control chamber. A total of 50 mL of drainage is not excessive in a client returning to the nursing unit from the recovery room. Drainage that is more than 70 to 100mL/hour is considered excessive and requires health care provider notification. The chest tube insertion site is covered with an occlusive (air-tight) dressing to prevent air from entering the pleural space. Positioning the drainage system below the client's chest allows gravity to drain the pleural space.

The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? 1. Exhales slowly 2. Stay very still 3. Inhale and exhale quickly 4. Perform the Valsalva maneuver

4. Rationale-When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is quickly withdrawn, and an air-tight 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.

The nurse is caring for a client who will be undergoing a chest tube insertion. The nurse knows she needs to have the following supplies at the bedside. Select all that apply. A. CDU unit B. Supplemental O2 C. Standby emergency airway equipment D. Suction E. Thoracotomy tray

A, B, C, E

The nurse is taking care of a client with a chest tube. On her initial assessment for the day she notes the chest tube has come out and is lying in the bed beside the client. Her immediate reaction is to A. Cover the hole with an occlusive dressing and notify the physician B. Apply supplemental O2 and notify the physician C. Cover the hole with a sterile dressing and notify the physician D. Call respiratory therapy to reinsert the chest tube

A. Cover the hole with an occlusive dressing and notify the physician

The nurse is caring for a client who has returned from surgery where they underwent a thoracotomy. A chest tube is in place. The nurse knows that the purpose of this chest tube is to A. Remove air or fluid thus restoring negative pressure within the pleural space to re expand the lung. B. To collect blood for autotransfusion C. To instill fluids into the pleural space D. Equalize pressure inside and outside the pleural space

A. Remove air or fluid thus restoring negative pressure within the pleural space to re expand the lung

The nurse is assessing the CDU unit of her client who has a chest tube. She notes that there is no tidying with normal respirations. Her best course of action is to A. Trouble shoot the system for kinking or clamping of the tubing B. Indicates an air leak and the tubing should be clamped C. Notify the physician D. Suspect a leak in the system and change the CDU unit

A. Trouble shoot the system for kinking or clamping of the tubing

What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems. A. Mediastinal chest tube system B. Dry suction chest tube system C. Wet suction chest tube system D. Dry-Wet suction chest tube system

B. Dry suction chest tube system

A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply: A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed. B. Gather supplies needed which will include a petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler's position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician. F. Place the patient is prone position after removal.

B. Gather supplies needed which will include a petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler's position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician. Option A: is wrong because this is not how the Valsalva Maneuver is performed (the correct way is detailed in option D). Option F: is wrong as well because this position would not faciltate breathing...Fowler's position is best after removal.

The nurse is taking care of a client with a chest tube. On entering the clients room she notes the client is experiencing extreme dyspnea and is cyanotic. On further assessment he appears to have tracheal deviation to the left. The nurse suspects a tension pneumothorax. The nurse knows the immediate treatment for a pneumothorax is to A. apply supplemental oxygen per nonrebreather mask B. Insert a needle into the left 2nd intercostal space in the mid-clavicular line to decompress the pneumothorax C. Sit the client in the semi-fowlers position and apply O2 to maintain SaO2 > 95% D. Insert a needle into the right and intercostal space in the mid-clavicular line to decompress the pneumothroax

B. Insert a needle into the left 2nd intercostal space in the mid-clavicular line to decompress the pneumothorax

While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention? A. Stay with the patient and monitor their vital signs while another nurse notifies the physician. B. Place a sterile dressing over the site and tape it on three sides and notify the physician. C. Attempt to re-insert the tube. D. Keep the site open to air and notify the physician.

B. Place a sterile dressing over the site and tape it on three sides and notify the physician.

A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this? A. This is an expected finding. B. The lung may have re-expanded or there is a kink in the system. C. The system is broken and needs to be replaced. D. There is an air leak in the tubing.

B. The lung may have re-expanded or there is a kink in the system.

The nurse is caring for a client who will be undergoing chest tube insertion. She will be assisting with the procedure. The nurse knows the most common location for chest tube insertion is A. Second intercostal space, mid axillary line B. Third intercostal space mid axillary line, lateral to the nipple C. Mid axillary line between the 4th and 5th ribs on a line lateral to the nipple D. At the base of the ribs to allow for better fluid drainage

C. Mid axillary line between the 4th and 5th ribs on a line lateral to the nipple

The nurse is assessing a client with a chest tube. Upon examining the area around the chest tube she notes some swelling at the site and crepitus on palpation of the area. The nurse knows that this is subcutaneous emphysema. Her best course of action at this time is to A. Reassess the area in two hours B. Just monitor the area. The SC emphysema will resolve on its own. C. Notify the physician. D. Apply nonocclusive dressing to the site.

C. Notify the physician

You are the RN taking care of a client with a chest tube. During your assessment you note that the tube has become disconnected from CDU unit. Your priority action is to A. Notify the physician B. Cover the end of the chest tube with an occlusive dressing. C. Submerge the tube 1 to 2 inches below the surface of a bottle of sterile water. D. Immediately reconnect the tubing to the CDU unit to prevent a pneumothorax.

C. Submerge the tube 1 to 2 inches below the surface of a bottle of sterile water.

You are an RN taking care of a client with a chest tube. On your assessment you note the client has improved respiratory status, symmetrical rise & fall of the chest, and normal bilateral breath sounds. There is minimal chest tube drainage and absence of bubbling in the water-seal chamber during expiration. The most likely explanation for these findings is A. These are expected findings in a client with a chest tube and you will continue to monitor B. The absence of bubbling indicates an air leak in the system C. The lung has re expanded and these are indications for chest tube removal. D. There is fluid in the tubing occluding the chest tube

C. The lung has re expanded and these are indications for chest tube removal

A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find? A. The water in the chamber will increase during inspiration and decrease during expiration. B. There will be continuous bubbling noted in the chamber. C. The water in the chamber will decrease during inspiration and increase during expiration. D. The water in the chamber will not move.

C. The water in the chamber will decrease during inspiration and increase during expiration. When a patient is receiving mechanical ventilation the water in the water seal chamber will oscillate oppositely than if the patient were breathing on their own. Therefore, the water in the chamber will decrease during inspiration and increase during expiration.

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

D. Check the drainage system for an air leak. Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak. However, oscillation of the water in the water seal chamber is normal.

The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY? A. Place the patient in supine position and clamp the tubing. B. Notify the physician immediately. C. Disconnect the drainage system and get a new one. D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system. Option D is the best choice. A new system needs to be obtained, however, in order to maintain a water seal until the new system arrives you will need to place the tubing 1 inch in sterile water or sterile saline to regain a water seal.

The nurse is assessing the CDU unit of a client with a chest tube. She notes continuous bubbling in the water-seal chamber. She suspects a leak in the system. The most appropriate action for the nurse is to A. Milk or strip the tubing to identify where the leak it B. Do nothing, the leak is outside the lung so will not have any effect on the chest tube C. Immediately change CDU unit D. Momentarily clamp the tubing at various points to locate the air leak

D. Momentarily clamp the tubing at various points to locate the air leak

A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system? A. Intermittent bubbling may be noted in the water seal chamber. B. 200 cc of drainage per hour is expected during recovery of a pneumothorax. C. The chest tube is positioned at the patient's chest level to facilitate drainage. D. All of these options are appropriate findings.

The answer is A. It is normal to find intermittent (NOT CONTINUOUS) bubbling in the water seal chamber if the patient is recovery from a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall....therefore air will escape into the water seal chamber causing intermittent bubbles.

You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention? A. Document your findings as normal. B. Assess for an air leak due to bubbling noted in the suction chamber. C. Notify the physician about the drainage. D. Milk the tubing to ensure patency of the tubes.

The assessment findings are normal. All the other options are incorrect.