1. You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding?
A. Reposition the patient because the tubing is kinked.
B. Continue to monitor the drainage system.
C. Increase the suction to the drainage system until the bubbling stops.
D. Check the drainage system for an air leak.
2. A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find?
A. The water in the chamber will increase during inspiration and decrease during expiration.
B. There will be continuous bubbling noted in the chamber.
C. The water in the chamber will decrease during inspiration and increase during expiration.
D. The water in the chamber will not move.
3. What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.
A. Mediastinal chest tube system
B. Dry suction chest tube system
C. Wet suction chest tube system
D. Dry-Wet suction chest tube system
4. The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
5. You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?
A. Document your findings as normal.
B. Assess for an air leak due to bubbling noted in the suction chamber.
C. Notify the physician about the drainage.
D. Milk the tubing to ensure patency of the tubes.
6. A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?
A. Intermittent bubbling may be noted in the water seal chamber.
B. 200 cc of drainage per hour is expected during recovery of a pneumothorax.
C. The chest tube is positioned at the patient's chest level to facilitate drainage.
D. All of these options are appropriate findings.
7. While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention?
A. Stay with the patient and monitor their vital signs while another nurse notifies the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
C. Attempt to re-insert the tube.
D. Keep the site open to air and notify the physician.
8. A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply:
A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed.
B. Gather supplies needed which will include a petroleum gauze dressing per physician preference.
C. Place the patient in Semi-Fowler's position.
D. Have the patient take a deep breath, exhale, and bear down during removal of the tube.
E. Pre-medicate prior to removal as ordered by the physician.
F. Place the patient is prone position after removal.
9. A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?
A. This is an expected finding.
B. The lung may have re-expanded or there is a kink in the system.
C. The system is broken and needs to be replaced.
D. There is an air leak in the tubing.
