Deck 26: Closed Chest Drainage

Question 1

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

Answer 1

Avoid dependent loops of the drainage tubing
Lift and clear the tube every 15 minutes

Question 2

Which condition may be treated with a Heimlich valve attached to a catheter inserted into the chest wall?

A) Hemothorax
B) Pleural effusion
C) Pneumothorax
D) Fluid drainage

Answer 2

Pneumothorax

Question 3

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 a 500 mm Hg pressure in the gravity blood cuff
D) Keeps the clamps open on the drainage tubing during bag transfer

Answer 3

Uses a microaggregate filter on the reinfusion bag

Question 4

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?

A) Malignancy
B) Pulmonary infarction
C) Empyema
D) Hemothorax

Question 5

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

Question 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

Question 7

What is the expected amount of drainage for an adult patient with a mediastinal chest tube?

A) Less than 50 to 200 mL/hour during the immediate postoperative period
B) Less than 10 mL/hour during the immediate postoperative period
C) 1000 mL/hour during the first 24-hour period
D) 200 mL/hour during the first 24-hour period

Question 8

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

Question 9

Trauma,disease,or surgery can result in air,blood,or fluid leaking into the intrapleural space,creating a positive pressure that collapses lung tissue.The usual intervention for larger leaks in a chest tube is to do which of the following? (Select all that apply.)

A) Remove air and fluid from the pleural space
B) Prevent air or fluid from reentering the pleural space
C) Reestablish normal intrapleural pressures
D) Reestablish normal intrapulmonary pressures
E) None of above

Question 10

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

Question 11

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

Question 12

An appropriate technique is followed while providing care for a patient with chest tubes when the nurse:

A) Applies an occlusive dressing over the site
B) "Strips" the tube on a regular basis
C) Assesses the patient hourly after insertion
D) Keeps excess loops of tubing from hanging over the side of the bed

Question 13

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

Question 14

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

Question 15

Which of the following is the correct positioning for a patient after a chest tube has been inserted for a hemothorax?

A) Supine
B) Side-lying
C) Semi-Fowler's
D) High-Fowler's

Question 16

What is the expected amount of drainage for an adult patient with a pleural chest tube?

A) 100 to 3000 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

Question 17

What condition is indicated when a patient with a chest tube experiences sharp stabbing chest pain without a change in pulse or blood pressure?

A) Pneumonitis
B) Tube displacement
C) A myocardial infarction
D) A tension pneumothorax

Question 18

A pneumothorax can be caused by which of the following? (Select all that apply.)

A) Trauma
B) Rupture of a blister
C) Emphysema
D) Dyspnea

Question 19

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

Question 20

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,knowing that the patient has a:

A) Hemothorax
B) Pneumothorax on the left side
C) Pneumothorax on the right side
D) Myocardial infarction

Question 21

A chest tube placed just below the sternum to prevent the accumulation of blood or fluid around the heart is called a ________________ chest tube.

Question 22

A ___________________ is a collapse of the lung caused by a collection of air in the pleural space.

Question 23

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

Question 24

The interior chest wall is covered with a membrane,called the _______________.

Question 25

A ______________ is a large catheter that is inserted through the thorax to remove fluid,blood,and/or air.

Question 26

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 does this indicate to the nurse? (Select all that apply.)

A) Malignancy
B) Pulmonary infarction
C) Empyema
D) Hemothorax

Question 27

A ____________ is a collapse of the lung caused by an accumulation of blood and fluid in the pleural cavity between the chest wall and the lung,usually as a result of trauma.

Question 28

The potential space between the visceral and parietal pleura is called the ________ and is filled with approximately 4 mL of lubricating fluid to help the pleura slide during respiration.

Question 29

Chest tubes placed low (usually in the fifth or sixth intercostal space)and posterior or lateral are used to _________________.

Question 30

The nurse is preparing to assist the physician in removal of a chest tube.What does 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

Question 31

The lungs are covered with a membrane called the _________________.

Question 32

_____________ are usually bilateral and occur from a variety of conditions,such as congestive heart failure,hepatic disease,or nephrotic syndrome.

Question 33

A __________________ occurs from rupture in the pleura when air accumulates in the pleural space more rapidly than it is removed.It is a life-threatening situation.

Question 34

An ________________ is usually unilateral,and the fluid is high in protein.It is the result of many clinical conditions such as cancer,infection,pancreatitis,connective tissue disease (e.g.,rheumatoid arthritis),or collagen vascular disease.