Chapter 18 - Chest Tube Insertion And Monitoring

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 clients room? (Select all that apply) 
A. Oxygen 
B. Sterile water
C. Enclosed hemostat clamps
D. Indwelling urinary catheter
E. Occlusive dressing

Answer 1

A. Oxygen
B. Sterile water
C. Enclosed hemostat clamps
E. Occlusive dressing

Question 2

A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the chest tube was accidentally removed. Which of the following actions should the nurse take first?
A. Obtain a chest x-ray
B. Apply sterile gauze to the insertion site
C. Place tape around the insertion site
D. Assess respiratory status

Answer 2

B. Apply sterile gauze to the insertion site

Question 3

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply)
A. Continuous bubbling in the water seal chamber
B. Gentle constant bubbling in the suction control chamber
C. Rise and fall in the level of water in the water seal chamber with inspiration and expiration
D. Exposed sutures without dressing
E. Drainage system upright at chest level

Answer 3

B. Gentle constant bubbling in the suction control chamber

C. Rise and fall in the level of water in the water seal chamber with inspiration and expiration

Question 4

A nurse is assisting a provider with the removal of a chest tube. Which of the following actions should the nurse take?
A. Instruct the client to lie prone with arms by the sides
B. Complete a surgical checklist on the client
C. Remind the client that there is minimal discomfort during the removal process
D. Place an occlusive dressing over the site once tube is removed

Answer 4

D. Place an occlusive dressing over the site once tube is removed

Question 5

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 and deep breathe
B. Check for continuous bubbling in the suction chamber
C. String the drainage tubing every 4 hr
D. Clamp the tube once a day
E. Obtain a chest X-ray

Answer 5

A. Encourage the client to cough and deep breathe
B. Check for continuous bubbling in the suction chamber
E. Obtain a chest X-ray