What should the nurse conclude if constant bubbling is noted in the water seal chamber of a closed chest drainage system?

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1) Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate?

1. Do nothing, because this is an expected finding.
2. Immediately clamp the chest tube and notify the physician.
3. Check for an air leak because the bubbling should be intermittent.
4. Increase the suction pressure so that bubbling becomes vigorous.

2) An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

1. A low respiratory
2. Diminished breathe sounds
3. The presence of a barrel chest
4. A sucking sound at the site of injury

3) A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:

1. Right pneumothorax
2. Pulmonary embolism
3. Displaced endotracheal tube
4. Acute respiratory distress syndrome

4) The physician inserts a chest tube into a female client to treat a pneumothorax. The tube is connected to water-seal drainage. The nurse in-charge can prevent chest tube air leaks by:

1. Checking and taping all connections.
2. Checking patency of the chest tube.
3. Keeping the head of the bed slightly elevated.
4. Keeping the chest drainage system below the level of the chest.

5) A client is diagnosed with a spontaneous pneumothorax necessitating the insertion of a chest tube. What is the best explanation for the nurse to provide this client?

1. “The tube will drain fluid from your chest.”
2. “The tube will remove excess air from your chest.”
3. “The tube controls the amount of air that enters your chest.”
4. “The tube will seal the hole in your lung.”

6) A client is diagnosed with a spontaneous pneumothorax necessitating the insertion of a chest tube. What is the BEST explanation for the nurse to provide this client?

1. “The tube will drain fluid from your chest.”
2. “The tube will remove excess air from your chest.”
3. “The tube controls the amount of air that enters your chest.”
4. “The tube will seal the hole in your lung.”

7) Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube?

1. You see a lot of drainage from the chest tube.
2. Arterial blood gas (ABG) levels are normal.
3. The chest X-ray continues to show the lung is 35% deflated.
4. The water-seal chamber doesn’t fluctuate when no suction is applied.

8) The nurse is going to replace the Pleur-O-Vac attached to the client with a small, persistent left upper lobe pneumothorax with a Heimlich Flutter Valve. Which of the following is the best rationale for this?

1. Promote air and pleural drainage
2. Prevent kinking of the tube
3. Eliminate the need for a dressing
4. Eliminate the need for a water-seal drainage

9) A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client’s vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following?

1. Spontaneous pneumothorax
2. Ruptured diaphragm
3. Hemothorax
4. Pericardial tamponade

10) The nurse is planning to teach the client about a spontaneous pneumothorax. The nurse would base the teaching on the understanding that:

1. Inspired air will move from the lung into the pleural space.
2. There is greater negative pressure within the chest cavity.
3. The heart and great vessels shift to the affected side.
4. The other lung will collapse if not treated immediately.

11) Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

1. The system is functioning normally
2. The client has a pneumothorax
3. The system has an air leak.
4. The chest tube is obstructed

12) In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:

1. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
2. Appneustic breathing, atypical pneumonia and respiratory alkalosis
3. Cheyne-Strokes respirations and spontaneous pneumothorax
4. Kussmail’s respirations and hypoventilation

13) After a lateral crushing chest injury, obvious right-sided paradoxic motion of the client’s chest demonstrates multiple rib fraactures, resulting in a flail chest. The complication the nurse should carefully observe for would be:

1. Mediastinal shift
2. Tracheal laceration
3. Open pneumothorax
4. Pericardial tamponade

14) When planning discharge teaching for a young female client who has had a pneumothorax, it is important that the nurse include the signs and symptoms of a pneumothorax and teach the client to seek medical assistance if she experiences:

1. Substernal chest pain
2. Episodes of palpitation
3. Severe shortness of breath
4. Dizziness when standing up

15) When caring for the a client with a pneumothorax, who has a chest tube in place, nurse Kate should plan to:

1. Administer cough suppressants at appropriate intervals as ordered
2. Empty and measure the drainage in the collection chamber each shift
3. Apply clamps below the insertion site when ever getting the client out of bed
4. Encourage coughing, deep breathing, and range of motion to the arm on the affected side

1. A. Do nothing, because this is an expected finding. Continuous gentle bubbling should be noted in the suction control chamber. Immediately clamp the chest tube and notify the physician is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Checking for an air leak because the bubbling should be intermittent is incorrect. Bubbling should be continuous and not intermittent. Increase the suction pressure so that bubbling becomes vigorous is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system.
2. B. Diminished breathe sounds. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.
3. A. Right pneumothorax . Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi.
4. A. Checking and taping all connections. Air leaks commonly occur if the system isn’t secure. Checking all connections and taping them will prevent air leaks. The chest drainage system is kept lower to promote drainage – not to prevent leaks.
5. B. “The tube will remove excess air from your chest.” The purpose of the chest tube is to create negative pressure and remove the air that has accumulated in the pleural space.
6. B. “The tube will remove excess air from your chest.” The purpose of the chest tube is to create negative pressure and remove the air that has accumulated in the pleural space.
7. D. The water-seal chamber doesn’t fluctuate when no suction is applied. The chest tube isn’t removed until the patient’s lung has adequately reexpanded and is expected to stay that way. One indication of reexpansion is the cessation of fluctuation in the water-seal chamber when suction isn’t applied. The chest X-ray should show that the lung is reexpanded. Drainage should be minimal before the chest tube is removed. An ABG test isn’t necessary if clinical assessment criteria are met.
8. D. Eliminate the need for a water-seal drainage . The Heimlich flutter valve has a one-way valve that allows air and fluid to drain. Underwater seal drainage is not necessary. This can be connected to a drainage bag for the patient’s mobility. The absence of a long drainage tubing and the presence of a one-way valve promote effective therapy
9. D. Pericardial tamponade . Pericardial tamponade occurs when there is presence of fluid accumulation in the pericardial space that compresses on the ventricles causing a decrease in ventricular filling and stretching during diastole with a decrease in cardiac output. . This leads to right atrial and venous congestion manifested by a CVP reading above normal.
10. B. There is greater negative pressure within the chest cavity. As a person with a tear in the lung inhales, air moves through that opening into the intrapleural and causes partial or complete collapse of the lungs.
11. C. The system has an air leak. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.
12. A. Respiratory acidosis, ateclectasis, and hypostatic pneumonia . Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.
13. A. Mediastinal shift . Mediastinal structures move toward the uninjured lung, reducing oxygenation and venous return.
14. C. Severe shortness of breath . This could indicate a recurrence of the pneumothorax as one side of the lung is inadequate to meet the oxygen demands of the body.
15. D. Encourage coughing, deep breathing, and range of motion to the arm on the affected side . All these interventions promote aeration of the re-expanding lung and maintenance of function in the arm and shoulder on the affected side.