Chest Tube Management Review: NCLEX Quiz

1. A potentially life-threatening condition in which air and pressure rapidly accumulate in the pleural space and, if not treated, can result in a mediastinal shift is called:

An open pneumothorax

A tension pneumothorax

An iatrogenic pneumothorax

A spontaneous pneumothorax

A tension pneumothorax is a potentially life-threatening condition in which air and pressure rapidly accumulate in the pleural space. If left untreated, it can lead to a mediastinal shift, which can further compromise the function of the heart and lungs. This condition typically occurs when there is a one-way valve mechanism that allows air to enter the pleural space but prevents it from escaping. As a result, the pressure in the pleural space continues to build up, causing the lung to collapse and putting pressure on the heart and vessels. Prompt treatment is necessary to relieve the pressure and restore normal lung function.

Explanation

A tension pneumothorax is a potentially life-threatening condition in which air and pressure rapidly accumulate in the pleural space. If left untreated, it can lead to a mediastinal shift, which can further compromise the function of the heart and lungs. This condition typically occurs when there is a one-way valve mechanism that allows air to enter the pleural space but prevents it from escaping. As a result, the pressure in the pleural space continues to build up, causing the lung to collapse and putting pressure on the heart and vessels. Prompt treatment is necessary to relieve the pressure and restore normal lung function.

2. The anatomical structure located in the center of the thoracic cavity is the:

Mediastinum

Visceral pleura

Parietal pleura

Diaphragm

The mediastinum is the central compartment of the thoracic cavity that houses various structures, including the heart, vessels, esophagus, trachea, and other important organs. The visceral and parietal pleura are associated with the lungs, while the diaphragm is a muscular structure separating the thoracic and abdominal cavities.

Explanation

The mediastinum is the central compartment of the thoracic cavity that houses various structures, including the heart, vessels, esophagus, trachea, and other important organs. The visceral and parietal pleura are associated with the lungs, while the diaphragm is a muscular structure separating the thoracic and abdominal cavities.

3. A patient with an opening in the chest wall, such as from a gunshot, stab wound, or impalement, resulting in a "sucking chest wound," can be said to have:

An open pneumothorax

A closed pneumothorax

A hemothorax

A pleural effusion

A patient with an opening in the chest wall, such as from a gunshot, stab wound, or impalement, resulting in a "sucking chest wound," can be said to have an "open pneumothorax." In an open pneumothorax, air is able to enter the pleural cavity through the wound in the chest wall, leading to changes in intrapleural pressure and potential lung collapse. The term "sucking chest wound" refers to the fact that during inhalation, air is drawn into the pleural cavity through the wound, creating a distinctive sucking sound. This condition requires prompt medical attention.

Explanation

A patient with an opening in the chest wall, such as from a gunshot, stab wound, or impalement, resulting in a "sucking chest wound," can be said to have an "open pneumothorax." In an open pneumothorax, air is able to enter the pleural cavity through the wound in the chest wall, leading to changes in intrapleural pressure and potential lung collapse. The term "sucking chest wound" refers to the fact that during inhalation, air is drawn into the pleural cavity through the wound, creating a distinctive sucking sound. This condition requires prompt medical attention.

4. What is the primary purpose of a chest tube in a patient with a pneumothorax?

To provide oxygen to the lungs

To drain excess fluid from the pleural space

To remove air from the pleural space

To measure intrathoracic pressure

The primary purpose of a chest tube in a patient with a pneumothorax is to remove air from the pleural space. By doing so, the chest tube helps re-establish negative intrapleural pressure, allowing the lung to re-expand and preventing further lung collapse. Chest tubes are instrumental in treating conditions such as pneumothorax and hemothorax by facilitating the drainage of air or fluid from the pleural cavity, promoting lung re-expansion, and restoring normal respiratory function.

Explanation

The primary purpose of a chest tube in a patient with a pneumothorax is to remove air from the pleural space. By doing so, the chest tube helps re-establish negative intrapleural pressure, allowing the lung to re-expand and preventing further lung collapse. Chest tubes are instrumental in treating conditions such as pneumothorax and hemothorax by facilitating the drainage of air or fluid from the pleural cavity, promoting lung re-expansion, and restoring normal respiratory function.

5. If the chest tube is pulled out of the patient's chest, and the patient had an air leak from the lung, after asking a colleague to call a physician STAT, emergency nursing management is to:

Cover the opening with a sterile dressing taped on three sides

Cover the opening with a sterile Vaseline gauze, taped securely on all sides

Leave the opening alone and monitor the patient until a physician can assess the situation.

Try to put the tube back in place as quickly as possible

If the chest tube is pulled out of the patient's chest and there is an air leak from the lung, covering the opening with a sterile dressing taped on three sides is the correct emergency nursing management. This is because it helps to prevent air from entering the pleural space and causing a pneumothorax. Taping the dressing on three sides allows for the escape of air while maintaining a seal. This temporary measure can be taken until a physician can assess the situation and determine the appropriate course of action.

Explanation

If the chest tube is pulled out of the patient's chest and there is an air leak from the lung, covering the opening with a sterile dressing taped on three sides is the correct emergency nursing management. This is because it helps to prevent air from entering the pleural space and causing a pneumothorax. Taping the dressing on three sides allows for the escape of air while maintaining a seal. This temporary measure can be taken until a physician can assess the situation and determine the appropriate course of action.

6.

Which of the following situations is likely to result in the absence of fluctuations in the chest drainage tubing?

The tubing is coiled on the bed with a straight path to the chest drain.

The tubing is blocked in some way.

The patient is receiving positive pressure ventilation.

The patient is ambulatory.

The situation likely to result in the absence of fluctuations in the chest drainage tubing is when the tubing is blocked in some way. Fluctuations in the chest drainage tubing typically occur during normal respiratory cycles as the patient breathes. When there is a blockage in the tubing, the flow of air or fluid is impeded, and the usual rise and fall of fluid levels or movement of the indicator may not be observed. This situation can affect the effectiveness of the chest drainage system and may require prompt attention to identify and address the blockage.

Explanation

The situation likely to result in the absence of fluctuations in the chest drainage tubing is when the tubing is blocked in some way. Fluctuations in the chest drainage tubing typically occur during normal respiratory cycles as the patient breathes. When there is a blockage in the tubing, the flow of air or fluid is impeded, and the usual rise and fall of fluid levels or movement of the indicator may not be observed. This situation can affect the effectiveness of the chest drainage system and may require prompt attention to identify and address the blockage.

7. The water seal is the most important element of the drainage system because:

It indicates the patency of the tubing by tidying with inspiration and expiration.

It allows air to enter the pleural space but prevent air from exiting the pleural space through the chest tube.

It allows air to exit the pleural space but prevent air from entering the pleural space through the chest tube.

It allows air to move freely in and out of the pleural space through the chest tube.

The water seal is the most important element of the drainage system because it allows air to exit the pleural space but prevents air from entering the pleural space through the chest tube. This is crucial in maintaining proper pressure within the pleural space and preventing complications such as pneumothorax. The water seal acts as a one-way valve, allowing air to be expelled from the pleural space during expiration but preventing air from entering during inspiration. This helps to restore normal lung function and promote healing.

Explanation

The water seal is the most important element of the drainage system because it allows air to exit the pleural space but prevents air from entering the pleural space through the chest tube. This is crucial in maintaining proper pressure within the pleural space and preventing complications such as pneumothorax. The water seal acts as a one-way valve, allowing air to be expelled from the pleural space during expiration but preventing air from entering during inspiration. This helps to restore normal lung function and promote healing.

8. Which of the following statements is true about intrapleural (the space between the parietal and visceral or pulmonary pleurae) pressure under normal conditions?

It is positive at rest.

It is negative during inhalation; positive during exhalation.

It is positive during inhalation; negative during exhalation.

It is negative at rest.

Under normal conditions, the intrapleural pressure, which refers to the pressure within the space between the parietal and visceral or pulmonary pleurae, is always negative. This negative pressure is crucial for maintaining the lungs in an expanded state and helps to prevent lung collapse. The negative pressure is created by the opposing forces of the elastic recoil of the lungs, which tends to collapse them, and the outward pull of the chest wall, which tends to expand them. This pressure gradient allows the lungs to adhere to the chest wall and facilitates the process of breathing.

Explanation

Under normal conditions, the intrapleural pressure, which refers to the pressure within the space between the parietal and visceral or pulmonary pleurae, is always negative. This negative pressure is crucial for maintaining the lungs in an expanded state and helps to prevent lung collapse. The negative pressure is created by the opposing forces of the elastic recoil of the lungs, which tends to collapse them, and the outward pull of the chest wall, which tends to expand them. This pressure gradient allows the lungs to adhere to the chest wall and facilitates the process of breathing.

9. When is it beneficial to clamp a patient's chest tube?

When ordered by a physician to simulate tube removal and assess the patient's response

Whenever a patient leaves the nursing unit and cannot be monitored

When ambulating a postoperative patient with a chest tube

It is never beneficial to clamp a patient's chest tube.

Clamping a patient's chest tube is beneficial when ordered by a physician to simulate tube removal and assess the patient's response. This allows the healthcare team to evaluate how the patient's lungs and respiratory system are functioning without the assistance of the chest tube. By temporarily clamping the tube, the physician can determine if the patient is ready for tube removal or if further intervention is needed. This assessment is crucial in ensuring the patient's safety and optimal recovery.

Explanation

Clamping a patient's chest tube is beneficial when ordered by a physician to simulate tube removal and assess the patient's response. This allows the healthcare team to evaluate how the patient's lungs and respiratory system are functioning without the assistance of the chest tube. By temporarily clamping the tube, the physician can determine if the patient is ready for tube removal or if further intervention is needed. This assessment is crucial in ensuring the patient's safety and optimal recovery.

10. Which of the following signs indicates a chest tube may be removed?

Drainage is approximately 100mL/hr in a patient with a pleural chest tube following spinal surgery.

The chest radiograph shows only a small residual pneumothorax in a patient requiring mechanical ventilation.

Bubbling in the water seal has been absent for 24 hours following iatrogenic pneumothorax from CVP placement.

Fluctuations in the water seal are approximately 2 to 4cmH2O with each breathing cycle.

Bubbling in the water seal indicates air leakage from the chest cavity. If the bubbling has been absent for 24 hours, it suggests that the air leak has resolved and the chest tube may be ready for removal.

Explanation

Bubbling in the water seal indicates air leakage from the chest cavity. If the bubbling has been absent for 24 hours, it suggests that the air leak has resolved and the chest tube may be ready for removal.

11. The following would result in a loss of the water seal:

Momentary tipping-over of the Atrium drainage system.

Evaporation of the water in the water seal chamber below the 2 cm mark.

Suction removed or turned off.

The drainage chambers are full.

Evaporation of the water in the water seal chamber below the 2 cm mark would result in a loss of the water seal. The water seal chamber in an Atrium drainage system is designed to create a barrier that prevents air from entering the patient's chest cavity while allowing fluid and air to escape. If the water in the water seal chamber evaporates below the 2 cm mark, the water seal will be compromised, and air may be able to enter the chest cavity, leading to potential complications.

Explanation

Evaporation of the water in the water seal chamber below the 2 cm mark would result in a loss of the water seal. The water seal chamber in an Atrium drainage system is designed to create a barrier that prevents air from entering the patient's chest cavity while allowing fluid and air to escape. If the water in the water seal chamber evaporates below the 2 cm mark, the water seal will be compromised, and air may be able to enter the chest cavity, leading to potential complications.

12. In self-contained, disposable chest drains, the manual high negative pressure relief valve

Allows water to be added to the system without disconnecting the patient tubing

Alerts the nurse to a situation of high pressure within the system and automatically vents

Allows filtered atmospheric air into the system to offset a rise in negative pressure

Alerts the nurse to high suction levels accumulating in the system

The manual high negative pressure relief valve in self-contained, disposable chest drains allows filtered atmospheric air into the system to offset a rise in negative pressure. This means that if the negative pressure in the system becomes too high, the valve will open and allow air to enter, balancing out the pressure. This is important because excessive negative pressure can be harmful to the patient.

Explanation

The manual high negative pressure relief valve in self-contained, disposable chest drains allows filtered atmospheric air into the system to offset a rise in negative pressure. This means that if the negative pressure in the system becomes too high, the valve will open and allow air to enter, balancing out the pressure. This is important because excessive negative pressure can be harmful to the patient.

13. In a self-contained, disposable chest drain, the amount of negative pressure transmitted to the patient by suction is determined by:

The amount of suction set on the wall vacuum regulator

The sensitivity of the high negative pressure relief valve

The dial setting on the suction control chamber

The level of water in the water seal chamber

The amount of negative pressure transmitted to the patient by suction in a self-contained, disposable chest drain is determined by the dial setting on the suction control chamber. This dial allows the healthcare provider to adjust the level of suction applied to the patient. By increasing or decreasing the dial setting, the amount of negative pressure can be adjusted accordingly.

Explanation

The amount of negative pressure transmitted to the patient by suction in a self-contained, disposable chest drain is determined by the dial setting on the suction control chamber. This dial allows the healthcare provider to adjust the level of suction applied to the patient. By increasing or decreasing the dial setting, the amount of negative pressure can be adjusted accordingly.

14. New bubbling is observed in the water seal chamber after a patient with a pleural chest tube returns from a test. The nurse clamps the chest tube momentarily with a tubing clamp at the dressing site. When this is done, bubbling in the water seal stops, the next appropriate nursing action is to:

Continue to monitor the water seal chamber for bubbling every hour for the next four hours.

Do nothing. This bubbling is normal in patients with pleural chest tubes.

Call the physician immediately and do not leave the patient's bedside because of the risk of respiratory failure.

The correct answer is to remove the chest tube dressing to see if one or more eyelets of the chest tube have been pulled out of the chest. This action is necessary because the bubbling in the water seal chamber stopped when the chest tube was clamped, indicating a possible disconnection or displacement of the tube. By removing the dressing, the nurse can visually inspect the chest tube and ensure its proper placement and function. This is important to prevent complications such as air leaks or pneumothorax. Continuing to monitor the water seal chamber or assuming the bubbling is normal could delay necessary interventions. Calling the physician may be necessary, but the immediate action is to assess the chest tube.

Explanation

The correct answer is to remove the chest tube dressing to see if one or more eyelets of the chest tube have been pulled out of the chest. This action is necessary because the bubbling in the water seal chamber stopped when the chest tube was clamped, indicating a possible disconnection or displacement of the tube. By removing the dressing, the nurse can visually inspect the chest tube and ensure its proper placement and function. This is important to prevent complications such as air leaks or pneumothorax. Continuing to monitor the water seal chamber or assuming the bubbling is normal could delay necessary interventions. Calling the physician may be necessary, but the immediate action is to assess the chest tube.

15. A physician has just performed a thoracostomy for pleural effusion. The nurse handed the patient tubing from the drain to the physician, who attached it to the chest tube. The drain is properly filled with water and placed in an upright position below the patient's chest. The physician orders suction to the chest drain system. With a dry suction control chamber (as is present in the Atrium Oasis), how should the nurse adjust the vacuum source?

Adjust the vacuum source until the dial on the vacuum regulator reads -20mmHg

Adjust the vacuum source until constant, gentle bubbling just begins in the suction control chamber

Adjust the vacuum source until the bellows indicator is all the way to the right of the indicator window

Adjust the vacuum source until the bellows indicator reaches the arrow mark in the indicator window

The correct answer is to adjust the vacuum source until the bellows indicator reaches the arrow mark in the indicator window. This is because the Atrium Oasis drain uses a dry suction control chamber, which means that the vacuum level is adjusted by positioning the bellows indicator. When the indicator reaches the arrow mark, it indicates that the desired level of suction has been achieved. Adjusting the vacuum source until the dial on the vacuum regulator reads -20mmHg is incorrect because this is not how the suction level is adjusted in the Atrium Oasis drain system. Adjusting the vacuum source until constant, gentle bubbling just begins in the suction control chamber is also incorrect because this is not how the suction level is determined in this type of drain system.

Explanation

The correct answer is to adjust the vacuum source until the bellows indicator reaches the arrow mark in the indicator window. This is because the Atrium Oasis drain uses a dry suction control chamber, which means that the vacuum level is adjusted by positioning the bellows indicator. When the indicator reaches the arrow mark, it indicates that the desired level of suction has been achieved. Adjusting the vacuum source until the dial on the vacuum regulator reads -20mmHg is incorrect because this is not how the suction level is adjusted in the Atrium Oasis drain system. Adjusting the vacuum source until constant, gentle bubbling just begins in the suction control chamber is also incorrect because this is not how the suction level is determined in this type of drain system.