The nurse is caring for a client with a chest tube. Which is the following statements is appropriate regarding a chest tube?
The chest tube drainage system should be placed on the bedside table.
The chest tube drainage system should be placed on the bed near the patient.
The chest tube drainage system must be placed below the site of insertion.
The chest tube drainage system should be placed on the siderail near the patient.
The Correct Answer is C
: Chest tube placement is done to remove air or fluid from the pleural space, which is the area between the lungs and the chest wall. The chest tube drainage system is an important tool to monitor and manage the drainage from the chest tube.
It is essential that the chest tube drainage system is placed below the level of the patient's chest and the site of insertion. This is necessary to create a continuous drainage system by allowing gravity to assist in the flow of air or fluid out of the pleural space. If the chest tube drainage system is placed above the insertion site, the fluid will not drain properly, which can cause the fluid to back up into the patient's chest cavity, leading to complications such as pneumothorax or hemothorax.
Therefore, the appropriate statement regarding a chest tube is that the chest tube drainage system must be placed below the site of insertion.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
In case of suspected ingestion of a poisonous substance, the priority response of the poison control nurse should be to assess the child's vital signs, especially breathing and heart rate, to determine if the child is experiencing any immediate life-threatening symptoms. This information will help the nurse determine the appropriate course of action, such as whether to instruct the caregiver to perform CPR or to immediately call for emergency medical assistance.
Asking about the substance ingested and the time of ingestion are also important pieces of information to gather, but they should not take priority over assessing the child's vital signs. Inducing vomiting is generally not recommended unless instructed to do so by a medical professional, as it can cause further harm if the substance ingested is corrosive or caustic.
Correct Answer is B
Explanation
Chest tubes are inserted to drain fluid, blood, or air from the pleural space, which is the space between the lung and the chest wall. It is important to ensure that the chest tube is secured properly and the drainage system is functioning properly before the patient is ambulated. Additionally, the patient may experience discomfort or pain during ambulation, so it is important to assess and manage the patient's pain before and after ambulation.
Option A is not appropriate because it disregards the patient's need to use the restroom and may make the patient feel helpless or dependent.
Option c is not appropriate because it does not address the patient's request for assistance and may make the patient feel neglected or uncared for.
Option d is not appropriate because it is a directive statement that does not take into account the patient's autonomy or individual needs. It is important to involve the patient in the decision-making process and provide appropriate care based on their individual needs and preferences.
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