NURS 1250 EXAM 1 QUESTIONS WITH VERIFIED
ANSWERS
What is a chest tube? - answers - a chest tube is a catheter inserted trough the thorax
to remove air and fluids from the pleural space
What is the purpose of a chest tube? - answers - -treat conditions that disrupt the
pleural space
-drains the pleural cavity of air, blood, pus, or lymph fluid
-prevent or mitigate post-op complications (cardiac surgery)
-to instill fluids into the pleural space (chemotherapy or sclerosing agents)
What are the indications for a chest tube? - answers - when air, blood, pus, or lymph
collects in the pleural cavity, negative pressure is lost and lung expansion is restricted
What is the pleural cavity? - answers - the potential space around the lungs
What is the overall goal of chest tube therapy? - answers - -promote lung re-expansion
-re-establish normal negative pleural space pressure
-restore adequate oxygen and ventilation
-prevention of complications
What is a pneumothorax? - answers - a collection of air in the pleural space
What occurs during a pneumothorax? - answers - there is a negative intrapleural
pressure, causing the lung to collapse
What is a secondary cause of a pneumothorax? - answers - -chest trauma (stabbing,
gunshot wound, rib fracture)
-rupture of an emphysematous bleb
-tearing of the pleura from an invasive procedure (surgery, insertion of a subclavian line,
mechanical ventilation)
What is a spontaneous pneumothorax? - answers - genetic condition that occurs
unexpectedly in healthy individuals who develop blebs (blister-like formations) on the
visceral pleura
Who is at an increased risk for spontaneous pneumothorax? - answers - tall, young men
When does a primary pneumothorax occur? - answers - in the absence of lung disease
or injury
,What is a chylothorax? - answers - lymphatic fluid accumulation in the pleural space, as
from:
-chest trauma
-an expanding tumor
-surgery within the mediastinum
What is the appearance of a chylothorax? - answers - milky-white pleural fluid
What is a hemothorax? - answers - blood in the pleural space, as from blunt or
penetrating trauma or chest surgery.
When does a massive hemothorax occur? - answers - when blood accumulates rapidly
in the chest cavity
-most often stems from penetrating or blunt trauma that disrupts systemic vessels
What is an empyema? - answers - purulent pleural fluid, which may be associated with
a lung assess
What is a pleural effusion? - answers - excessive fluid in the pleural space
What are the causes of pleural effusion? - answers - -left ventricle failure
-pulmonary embolism
-pneumonia
-cancer
-conditions that impede pleural fluid drainage (such as a tumor that blocks the lymphatic
system)
-complication of surgery
-complication of fluid shifts (liver or renal failure)
What is the most common complication of chest tube placement? - answers -
malposition
What occurs with malposition of chest tube placement? - answers - persistent air or fluid
in the pleural space, resulting in the chest tube ending to be repositioned
What is a minor complication of chest tube placement? - answers - bleeding, most
common during insertion
What may bleeding into the lung require? - answers - surgical intervention
Who do we need to pay special attention to when placing a chest tube? - answers - to
patients on anticoagulation therapy or with a clotting disorder
When does lung trauma and perforation of the diaphragm occur? - answers - during
insertion if the chest tube is inserted too low
,What is the relationship between chest tube and infection? - answers - -increases with
duration of tube placement
-sterile technique is essential for placement
-watch for oozing, drainage or erythema at insertion site
-high risk category are those that are immunocompromised
What is subcutaneous emphysema? - answers - air leaks from the pearl space into the
subcutaneous tissue after a chest tube placement that affects the tissue of the neck,
face, axilla, and chest wall
What is the clinical finding associated with subcutaneous emphysema? - answers -
crepitus (crackling like rice crispies) on palpation
-if severe enough, can cause compression of the upper airway and jugular venous
distention
Where can chest tubes be placed? - answers - -er
-patients room
-operating room
How do we prepare a patient for a chest tube placement? - answers - -explain
procedure to patient
-informed consent should be obtained , if possible
-provide supplemental oxygen
-monitor the patient (vital signs, electronic monitoring equipment)
-an analgesic or sedating agent may be given
-patient is placed in sitting or lying position, with affected side elevated. The patients
arm is brought over the head and secured
-area is cleansed with an antiseptic solution
-a local anesthetic is given to the area
-a small incision is made and the chest tube is inserted
-the chest tube is sutured to the chest wall
-the insertion site is covered with an occlusive dressing
-the chest tube is connected to the drainage system
Where is the chest tube placed if the function is the remove air? - answers - inserted at
the mid-clavicular, second intercostal space, near the apex of the lung
Where is the chest tube placed if the function is the remove fluid? - answers - placed
inferior and posterior in the pleural space, mid-axillary line, 7th and 8th intercostal space
What are the documentation components after the initial chest tube is placed? -
answers - -vital signs before and after the procedure
-chest tube size and insertion site
-physician inserting the chest tube
-drainage present, and the type and amount
, -type of drainage system and the ordered suction present
-were cultures sent
-how did the patient tolerate the procedure
-medications given
-resulting of the chest x-ray post chest tube insertion
-patient and family teaching
What are the ongoing patient assessments after the chest tube insertion? - answers - -
vital signs
-respiratory rate, pattern, status, depth
-ease of respiration
-oxygen saturation
-assess for any manifestations of re-accumulation of air and fluid in the chest=
decreased or absent breath sounds
-signs of respiratory distress include tachypnea, dyspnea, shortness of breath,
tachycardia, decreased or absent breath sounds, and use of accessory muscles
-inspect the chest tube insertion site for drainage, erythema, subcutaneous emphysema
-dressing is dry and intact
-look for signs of infection (fever, increased wbc)
-pain/ discomfort (medication as needed)
-skin color
Slide 23 and 24 of 36 - answers -
What is the difference between wet and dry chest tube system? - answers - -wet suction
regulate suction pressure by the height of the column of water in the suction control
chamber
-dry suction regulate pressure mechanically rather than with a column of water. Since
there is no bubbling in the dry suction control chamber, the orange bellows are used as
a visual indicator of suction operation
What are the 2 chest tube suction systems? - answers - -wet
-dry
*true or false:* a suction pressure of +20 cm h2o is commonly recommended for adults -
answers - false, -20cm
What is the tube dislodgment or disconnection emergency equipment that should be
help at the bedside? - answers - -keep rubber tipped or padded hemostats at bedside
-vaseline gauze
-dry sterile dressings
-tape
-sterile water
What are the indications for removing the chest tube? - answers - -when lungs are fully
expanded
ANSWERS
What is a chest tube? - answers - a chest tube is a catheter inserted trough the thorax
to remove air and fluids from the pleural space
What is the purpose of a chest tube? - answers - -treat conditions that disrupt the
pleural space
-drains the pleural cavity of air, blood, pus, or lymph fluid
-prevent or mitigate post-op complications (cardiac surgery)
-to instill fluids into the pleural space (chemotherapy or sclerosing agents)
What are the indications for a chest tube? - answers - when air, blood, pus, or lymph
collects in the pleural cavity, negative pressure is lost and lung expansion is restricted
What is the pleural cavity? - answers - the potential space around the lungs
What is the overall goal of chest tube therapy? - answers - -promote lung re-expansion
-re-establish normal negative pleural space pressure
-restore adequate oxygen and ventilation
-prevention of complications
What is a pneumothorax? - answers - a collection of air in the pleural space
What occurs during a pneumothorax? - answers - there is a negative intrapleural
pressure, causing the lung to collapse
What is a secondary cause of a pneumothorax? - answers - -chest trauma (stabbing,
gunshot wound, rib fracture)
-rupture of an emphysematous bleb
-tearing of the pleura from an invasive procedure (surgery, insertion of a subclavian line,
mechanical ventilation)
What is a spontaneous pneumothorax? - answers - genetic condition that occurs
unexpectedly in healthy individuals who develop blebs (blister-like formations) on the
visceral pleura
Who is at an increased risk for spontaneous pneumothorax? - answers - tall, young men
When does a primary pneumothorax occur? - answers - in the absence of lung disease
or injury
,What is a chylothorax? - answers - lymphatic fluid accumulation in the pleural space, as
from:
-chest trauma
-an expanding tumor
-surgery within the mediastinum
What is the appearance of a chylothorax? - answers - milky-white pleural fluid
What is a hemothorax? - answers - blood in the pleural space, as from blunt or
penetrating trauma or chest surgery.
When does a massive hemothorax occur? - answers - when blood accumulates rapidly
in the chest cavity
-most often stems from penetrating or blunt trauma that disrupts systemic vessels
What is an empyema? - answers - purulent pleural fluid, which may be associated with
a lung assess
What is a pleural effusion? - answers - excessive fluid in the pleural space
What are the causes of pleural effusion? - answers - -left ventricle failure
-pulmonary embolism
-pneumonia
-cancer
-conditions that impede pleural fluid drainage (such as a tumor that blocks the lymphatic
system)
-complication of surgery
-complication of fluid shifts (liver or renal failure)
What is the most common complication of chest tube placement? - answers -
malposition
What occurs with malposition of chest tube placement? - answers - persistent air or fluid
in the pleural space, resulting in the chest tube ending to be repositioned
What is a minor complication of chest tube placement? - answers - bleeding, most
common during insertion
What may bleeding into the lung require? - answers - surgical intervention
Who do we need to pay special attention to when placing a chest tube? - answers - to
patients on anticoagulation therapy or with a clotting disorder
When does lung trauma and perforation of the diaphragm occur? - answers - during
insertion if the chest tube is inserted too low
,What is the relationship between chest tube and infection? - answers - -increases with
duration of tube placement
-sterile technique is essential for placement
-watch for oozing, drainage or erythema at insertion site
-high risk category are those that are immunocompromised
What is subcutaneous emphysema? - answers - air leaks from the pearl space into the
subcutaneous tissue after a chest tube placement that affects the tissue of the neck,
face, axilla, and chest wall
What is the clinical finding associated with subcutaneous emphysema? - answers -
crepitus (crackling like rice crispies) on palpation
-if severe enough, can cause compression of the upper airway and jugular venous
distention
Where can chest tubes be placed? - answers - -er
-patients room
-operating room
How do we prepare a patient for a chest tube placement? - answers - -explain
procedure to patient
-informed consent should be obtained , if possible
-provide supplemental oxygen
-monitor the patient (vital signs, electronic monitoring equipment)
-an analgesic or sedating agent may be given
-patient is placed in sitting or lying position, with affected side elevated. The patients
arm is brought over the head and secured
-area is cleansed with an antiseptic solution
-a local anesthetic is given to the area
-a small incision is made and the chest tube is inserted
-the chest tube is sutured to the chest wall
-the insertion site is covered with an occlusive dressing
-the chest tube is connected to the drainage system
Where is the chest tube placed if the function is the remove air? - answers - inserted at
the mid-clavicular, second intercostal space, near the apex of the lung
Where is the chest tube placed if the function is the remove fluid? - answers - placed
inferior and posterior in the pleural space, mid-axillary line, 7th and 8th intercostal space
What are the documentation components after the initial chest tube is placed? -
answers - -vital signs before and after the procedure
-chest tube size and insertion site
-physician inserting the chest tube
-drainage present, and the type and amount
, -type of drainage system and the ordered suction present
-were cultures sent
-how did the patient tolerate the procedure
-medications given
-resulting of the chest x-ray post chest tube insertion
-patient and family teaching
What are the ongoing patient assessments after the chest tube insertion? - answers - -
vital signs
-respiratory rate, pattern, status, depth
-ease of respiration
-oxygen saturation
-assess for any manifestations of re-accumulation of air and fluid in the chest=
decreased or absent breath sounds
-signs of respiratory distress include tachypnea, dyspnea, shortness of breath,
tachycardia, decreased or absent breath sounds, and use of accessory muscles
-inspect the chest tube insertion site for drainage, erythema, subcutaneous emphysema
-dressing is dry and intact
-look for signs of infection (fever, increased wbc)
-pain/ discomfort (medication as needed)
-skin color
Slide 23 and 24 of 36 - answers -
What is the difference between wet and dry chest tube system? - answers - -wet suction
regulate suction pressure by the height of the column of water in the suction control
chamber
-dry suction regulate pressure mechanically rather than with a column of water. Since
there is no bubbling in the dry suction control chamber, the orange bellows are used as
a visual indicator of suction operation
What are the 2 chest tube suction systems? - answers - -wet
-dry
*true or false:* a suction pressure of +20 cm h2o is commonly recommended for adults -
answers - false, -20cm
What is the tube dislodgment or disconnection emergency equipment that should be
help at the bedside? - answers - -keep rubber tipped or padded hemostats at bedside
-vaseline gauze
-dry sterile dressings
-tape
-sterile water
What are the indications for removing the chest tube? - answers - -when lungs are fully
expanded
