A nurse is caring for a client who has a chest tube inserted for a pneumothorax. Which of the following actions should the nurse take?
Empty the collection chamber on the client’s chest tube every 4 hr.
Strip the client’s chest tube every 2 hr.
Pin the chest tube to the client’s gown.
Tape the connections on the client’s chest tube.
The Correct Answer is D
Choice A reason: Emptying the collection chamber every 4 hours is unnecessary and can increase the risk of introducing infection. The chamber should be emptied as needed based on the volume of drainage.
Choice B reason: Stripping the chest tube, which involves squeezing and releasing sections of the tube to move clots, is not recommended as it can create high negative pressure and cause damage to the lung tissue.
Choice C reason: Pinning the chest tube to the client’s gown can lead to accidental dislodgement. The chest tube should be secured appropriately without tension.
Choice D reason: The correct answer is d because taping the connections on the client’s chest tube ensures that the system remains airtight and prevents air leaks, which is essential for effective functioning of the chest tube and prevention of pneumothorax recurrence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Resting before meals helps reduce fatigue and ensures that the client has the energy to eat, which is important for maintaining nutrition in COPD patients.
Choice B reason: The correct answer is b because drinking plenty of beverages with meals can cause the client to feel full too quickly, reducing their intake of nutrient-dense foods. It is better to drink fluids between meals to ensure adequate nutrition.
Choice C reason: Eating five or six small meals each day helps prevent overeating and reduces the work of breathing, making it easier for COPD clients to maintain adequate nutrition without feeling overly full or short of breath.
Choice D reason: Increasing protein intake is important for COPD clients to maintain muscle mass and strength, which are crucial for respiratory function and overall health.
Correct Answer is B
Explanation
Choice A reason: Phenazopyridine is a urinary tract analgesic used to relieve symptoms such as burning, pain, and urgency during urination. It should reduce burning during urination, not cause it.
Choice B reason: The correct answer is b because reddish-orange urine is a common and expected side effect of phenazopyridine. The medication can cause discoloration of urine, which is harmless but important for clients to be aware of to avoid unnecessary concern.
Choice C reason: Visual disturbances are not a known side effect of phenazopyridine. Clients should be informed to report any unusual symptoms, but this is not typically associated with the medication.
Choice D reason: Lethargy is also not a common side effect of phenazopyridine. The medication primarily acts on the urinary tract and does not generally cause significant systemic effects.
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