Review Practice Exercise 1

Chest Tube Insertion and Monitoring > Adult Health

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Practice Exercise 1

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Total Questions : 5

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Question 1:

A nurse is preparing to care for a client following chest tube placement. Which of the following items should be available in the client’s room? Select all that apply

A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing

Answer and Explanation

Choice A:

Oxygen: Chest tube insertion is often performed for conditions such as pneumothorax or hemothorax, where oxygenation can be compromised. Supplemental oxygen should be readily available to support ventilation and oxygen delivery, especially if respiratory distress occurs.

Choice B:

Sterile water: Sterile water (or sterile saline) is essential to maintain or reestablish the water seal in the drainage system if it becomes disrupted. It may also be used to immerse the tube’s end temporarily if the drainage system disconnects, preventing air from entering the pleural space.

Choice C:

Enclosed hemostat clamps: Two sterile, rubber-tipped or enclosed hemostat clamps are kept at the bedside for brief, emergency clamping—such as changing the drainage system or identifying air leaks. Clamps should never be used continuously, as this can cause a tension pneumothorax.

Choice D:

Indwelling urinary catheter: This is not routinely required for chest tube management. A urinary catheter is indicated only if close urine output monitoring is necessary due to other medical reasons, not specifically for chest tube care.

Choice E:

Occlusive dressing: If the chest tube accidentally comes out, an occlusive (petroleum gauze) dressing should be immediately applied over the site to prevent air entry into the pleural space, which could cause a pneumothorax.

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Question 2:

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? Select all that apply

A. Encourage the client to cough every 2 hr. B. Check for continuous bubbling in the suction chamber. C. Strip the drainage tubing every 4 hr. D. Clamp the tube once a day. E. Obtain a chest x-ray.

Answer and Explanation

Choice A:

Encourage the client to cough every 2 hr: Coughing and deep breathing exercises promote lung expansion, facilitate drainage of air and fluid, and prevent atelectasis. Regular pulmonary hygiene supports recovery and prevents respiratory complications.

Choice B:

Check for continuous bubbling in the suction chamber: Continuous bubbling in the suction control chamber indicates that the suction source is functioning properly. However, intermittent bubbling should occur only in the water-seal chamber during exhalation or coughing—continuous bubbling there suggests an air leak.

Choice C:

Strip the drainage tubing every 4 hr: Stripping or milking the tubing can create high negative pressure in the pleural space, causing tissue damage and promoting air leaks. The tubing should instead be kept free of kinks and dependent loops without stripping.

Choice D:

Clamp the tube once a day: Routine clamping is contraindicated because it can lead to tension pneumothorax from trapped air. Clamping is done only briefly and under specific conditions, such as changing the drainage system or checking for leaks.

Choice E:

Obtain a chest x-ray: A chest x-ray is obtained after insertion to confirm the tube’s correct placement and lung re-expansion. It also serves as a baseline for monitoring future progress and identifying potential complications such as malposition or pneumothorax recurrence.

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Question 3:

A nurse checks on a client following a lower lobectomy for lung cancer. The nurse finds that the client is dyspneic with respirations in the 40s, is hypotensive, has an SaO₂ of 86% on 10 L via a close-fitting oxygen mask, has a trachea deviated slightly to the left, and notes that the right side of the chest is not expanding. Which action should the nurse take first?

A. Notify the physician B. Give the client the prescribed medication to decrease anxiety C. Check the chest tube to make sure it is not obstructed D. Turn up the oxygen liter flow

Answer and Explanation

Choice A:

Notify the physician: While the physician must be notified promptly, assessment and correction of a potentially obstructed chest tube take priority because the client is in acute respiratory distress. Delaying to make a call without addressing the cause could worsen hypoxia and hemodynamic instability.

Choice B:

Give the client the prescribed medication to decrease anxiety: The client’s anxiety is secondary to severe hypoxia. Sedation could further depress respiratory function and delay life-saving intervention. The focus must be on resolving the underlying cause of respiratory distress.

Choice C:

Check the chest tube to make sure it is not obstructed: These symptoms indicate that air is accumulating in the pleural space, collapsing the lung and shifting the mediastinum. An obstructed or clamped chest tube prevents air escape, causing rising intrathoracic pressure. The nurse must first assess and ensure the tube is patent and properly functioning. If obstructed, immediate intervention is needed to restore drainage and prevent cardiopulmonary collapse.

Choice D:

Turn up the oxygen liter flow: Increasing oxygen flow will not correct the problem because the issue is not oxygen delivery but air trapping from impaired chest tube function. Without reestablishing lung expansion, oxygenation cannot improve.

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Question 4:

When should the nurse check for leaks in the chest tube and pleural drainage system?

A. There is continuous bubbling in the water-seal chamber. B. There is constant bubbling of water in the suction control chamber. C. Fluid in the water-seal chamber fluctuates with the patient’s breathing. D. The water levels in the water-seal and suction control chambers are decreased.

Answer and Explanation

Choice A:

There is continuous bubbling in the water-seal chamber: Intermittent bubbling during exhalation or coughing is normal as air exits the pleural space. However, continuous bubbling suggests that air is entering the system from an external source—such as a loose connection, cracked tubing, or dislodged drain. The nurse should systematically check the tubing, connections, and drainage unit to identify the leak’s origin.

Choice B:

There is constant bubbling of water in the suction control chamber: Continuous bubbling in the suction control chamber is expected and indicates that suction is functioning properly. The intensity of bubbling can be adjusted by regulating the suction source but does not signify a leak.

Choice C:

Fluid in the water-seal chamber fluctuates with the patient’s breathing: This is called tidaling and is a normal finding, reflecting changes in intrathoracic pressure during respiration. The absence of tidaling may indicate lung re-expansion or an obstruction in the tubing—not an air leak.

Choice D:

The water levels in the water-seal and suction control chambers are decreased: A drop in water levels indicates evaporation or loss of sterile fluid, not a leak. The nurse should simply add sterile water to the prescribed levels to maintain proper function.

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Question 5:

An unlicensed assistive personnel (UAP) is taking care of a patient with a chest tube. The nurse should intervene when she observes the UAP:

A. Looping the drainage tubing on the bed. B. Securing the drainage container in an upright position. C. Stripping or milking the chest tube to promote drainage. D. Reminding the patient to cough and deep breathe every 2 hours.

Answer and Explanation

Choice A:

Looping the drainage tubing on the bed: While the tubing should not be allowed to hang loosely or kink, looping it on the bed temporarily without dependent loops is acceptable as long as drainage flows freely and the tubing is below chest level. The nurse should ensure there are no obstructions, but this action alone does not require intervention.

Choice B:

Securing the drainage container in an upright position: This is correct and safe practice. The drainage system should always remain upright and below the patient’s chest to facilitate drainage and prevent backflow of fluid into the pleural space.

Choice C:

Stripping or milking the chest tube to promote drainage: This action is contraindicated because it can generate excessive negative intrathoracic pressure, leading to lung injury or tissue trauma. Proper drainage depends on gravity and a functioning water-seal system, not manual manipulation. The UAP should never perform this action, and the nurse must provide education on safe chest tube handling.

Choice D:

Reminding the patient to cough and deep breathe every 2 hours: This is an appropriate intervention that promotes lung expansion, prevents atelectasis, and helps re-expand the affected lung following chest surgery or pneumothorax.

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Practice Exercise 1

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