Quiz 77: Closed Chest Drainage Systems
Perry et al.: Clinical Nursing Skills & Techniques, 9th Edition
Instructor Verified Answers Included
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1. The nurse is caring for a patient who is comatose and on a ventilator. When she enters the room, she notices that the patient’s trachea has shifted toward the left side of the patient’s neck, and he has become tachycardic. She assesses the patient’s blood pressure and notes that it is 84/38. The nurse calls for help, having recognized that the patient has developed which of the following conditions?
b. Pneumothorax on the left side
c. Pneumothorax on the right side
d. Myocardial infarction
2. For a patient with a pneumothorax, where does the nurse anticipate that the chest tube will be located?
a. Second to third intercostal space (apical), anterior
b. Fifth to sixth intercostal space, posterior
c. Fifth to sixth intercostal space, lateral
d. Mediastinal area
3. The patient’s chest tube is attached to a one-way flutter valve that allows air to escape the chest cavity and prevents air from reentering. How does the nurse document this finding?
a. Heimlich chest drain valve
c. Water seal
4. The nurse is caring for a patient who has a chest tube connected to a water seal. The patient is not on a ventilator. Which of the following would the nurse consider normal?
a. The fluid level in the water seal rises with inspiration.
b. The fluid level in the water seal falls with inspiration.
c. Constant bubbling occurs in the water seal.
d. The fluid level in the water seal falls with expiration 3 days after insertion.
5. The nurse is caring for a patient with a chest tube that was inserted 4 days earlier. She notices that the drainage contains a large amount of pus. What does the presence of the pus indicate?
b. Pulmonary infarction
6. What is indicated by continuous bubbling in the water-seal chamber with no bubbles noted in the suction-control chamber of the drainage system?
a. A leak in the system
b. Normal functioning
c. A drainage obstruction
d. Insufficient suction pressure
7. What condition is indicated when a patient with a chest tube experiences sharp, stabbing chest pain without a change in pulse or blood pressure?
b. Tube displacement
c. A myocardial infarction
d. A tension pneumothorax
8. Which of the following is an expected outcome of chest tube insertion?
a. Mild chest pain is maintained.
b. Breath sounds are auscultated in all lobes.
c. Drainage from the pleural cavity increases over time.
d. Lung expansion is increased beyond the unaffected side.
9. What should the nurse do to establish a two-chamber waterless chest tube system?
a. Add sterile water to the suction chamber.
b. Add sterile solution to the water seal.
c. Set the float ball to the correct drainage pressure.
d. Connect directly to the chest tube and add nothing.
10. Which of the following represents appropriate technique when providing care for a patient with chest tubes?
a. Applying an occlusive dressing over the site
b. “Stripping” the tube on a regular basis
c. Assessing the patient hourly after insertion
d. Keeping excess loops of tubing from hanging over the side of the bed
11. Which of the following is the correct positioning for a patient after a chest tube has been inserted for a pneumothorax?
12. What is the expected amount of drainage for an adult patient with a mediastinal chest tube?
a. Less than 100 mL/hr during the immediate postoperative period
b. Less than 10 mL/hr during the immediate postoperative period
c. 1000 mL/hr during the first 24-hour period
d. 200 mL/hr during the first 24-hour period
13. What is the expected amount of drainage for an adult patient with a posterior chest tube?
a. 100 to 300 mL during the first 3 hours
b. 10 to 50 mL during the first 2 hours
c. 200 mL during the first 24 hours
d. 400 to 500 mL during the first 24 hours
14. A nurse determines that there may be a leak in the chest tube system. Clamps are applied near the patient’s chest, and the nurse finds that the bubbling stops. What should the nurse do next?
a. Change the tubing.
b. Change the drainage container.
c. Move the clamps farther down the chest tube.
d. Reinforce the dressing and notify the physician.
15. During assessment of a patient, the chest tube becomes dislodged. What should the nurse do first?
a. Have an assistant apply an occlusive gauze dressing and tape on all four sides.
b. Clamp the chest tube.
c. Attempt to gently reinsert the tube.
d. Apply pressure over the insertion site.
16. What does the expected role of the nurse include during chest tube removal?
a. Prepares an occlusive dressing.
b. Performs clipping of the sutures.
c. Provides support and assessment of the patient.
d. Removes the chest tube firmly and quickly.
17. Appropriate intervention for the patient who is having a reinfusion of chest tube drainage is noted when the nurse:
a. hangs the reinfusion lower than the usual intravenous (IV) bag.
b. uses a microaggregate filter on the reinfusion bag.
c. maintains 500 mm Hg pressure in the gravity blood cuff.
d. keeps the clamps open on the drainage tubing during bag transfer.
18. Of the following nursing assessments, which should be reported to the primary care provider immediately by the nurse?
a. Bloody drainage from a patient with a hemothorax
b. Subcutaneous emphysema is noted on assessment.
c. Bubbling in the water seal stops on a patient with a pneumothorax.
d. Over 300 mL of drainage has been collected in the system in the past hour.
19. The nurse is providing care for a patient with a pneumothorax. She anticipated removal of the chest tube because of the absence of an air leak for the past _____ hours.
a. 6 to 8
b. 12 to 16
c. 18 to 24
d. 48 to 72
20. The nurse is caring for a patient with blood collecting in the pleural space. The nurse documents this as:
a. pleural effusion.
c. pulmonary hemorrhage.
21. The nurse knows that _______________ is the proper term to describe that the patient’s water seal is fluctuating up and down with each breath.
22. The nurse is caring for a patient with a chest tube connected to water-seal drainage. The nurse may delegate which of the following tasks to nursing assistive personnel (NAP)?
a. Changing the chest tube drainage system
b. Milking the chest tube
c. Measuring chest tube output
d. Turning and positioning the patient
23. The patient has a chest tube for a pneumothorax. Assessment revealed continuous bubbling in the water-seal chamber. The nurse finds no loose connections. After the chest tube near the patient is clamped, the bubbling stops. The nurse’s first action should be to:
a. apply pressure to the dressing around the chest tube insertion site.
b. move the clamp farther down the tube and note whether bubbling resumes.
c. replace the entire collection tubing and system.
d. increase suction control until bubbling does not resume when the clamp is removed.
1. A pneumothorax can be caused by which of the following? (Select all that apply.)
b. Rupture of a blister
2. The nurse is caring for a patient with a chest tube connected to wall suction. To keep the tube patent, the nurse should implement which of the following? (Select all that apply.)
a. Routinely “milk” the drainage tubing.
b. Avoid dependent loops of the drainage tubing.
c. Lift and clear the tube every 15 minutes.
d. Coil the drainage tubing to prevent dependent loops.
3. The nurse is caring for a patient with a chest tube that was inserted 4 days earlier. She notices that the drainage is blood-tinged. What might this indicate to the nurse? (Select all that apply.)
b. Pulmonary infarction
4. The nurse is preparing to assist the physician in removal of a chest tube. What should the nurse do to prepare the patient? (Select all that apply.)
a. Assess the patient’s need for pain medication.
b. Instruct the patient about the process.
c. Teach the patient to take a deep breath and hold it.
d. Clamp the chest tubes.
5. The nurse is caring for a patient who has a chest tube. Attached to the top of the patient’s bed are two shodded hemostats. In which situations would these be used? (Select all that apply.)
a. To assess an air leak
b. To quickly empty or change disposable systems
c. To quickly seal off the lungs if the system becomes disconnected
d. To assess whether the patient is ready to have the chest tube removed
6. The nurse is performing an initial assessment of a patient with a chest tube placed in the eighth intercostal space. Which of the following findings would the nurse need to assess further? (Select all that apply.)
a. Respiratory rate of 18 breaths per minute
b. Continuous bubbling in the water-seal chamber
c. The presence of subcutaneous emphysema
d. Complaints of pain at the insertion site
e. Serous drainage on the chest tube dressing the size of a bean
7. The nurse is caring for a patient who has had a chest tube in place for 2 days. As the nurse begins her shift assessment, she should ensure that what equipment is at the bedside? (Select all that apply.)
a. Two rubber-tipped clamps
b. Plain gauze 4 4
c. Sterile petroleum gauze
d. Extra drainage system
e. A sterile chest tube of the same size as the one inserted in the patient