CARDIAC SURGERY CSC TEST PAPER EXAMS
QUESTIONS AND ANSWERS SURE A+
✔✔In caring for a patient with chest tubes the nurse knows the following to be true
concerning drainage:
A. A patient with decreased breath sounds and increased inspiratory pressures on the
ventilator but with no drainage in the chest tube might have a collection of undrained
blood in the pleural space.
B. Dumping of blood into the chest tube with a position change is usually related to a
new bleed.
C. Chest tubes can safely be removed as long as the amount of drainage is < 500 ml
per 8 hours.
D. Aggressive stripping is necessary to keep the drainage tube patent. - ✔✔A. A
change in patient condition, such as decreased breath sounds and increased inspiratory
pressures on the ventilator alarm, may indicate blood in the pleural space that has not
been effectively drained by the chest tube.
Aggressive stripping of the chest tube can cause a negative pressure of over 300 cm of
H2O and this can cause further bleeding and is painful for the patient.
When a dumping of blood occurs with a position change this can represent either new
or old blood. The color of the blood as well as other changes in the patient condition can
be used to help assess the acuity of the bleeding.
Chest tubes are typically not removed until the amount of drainage is less than 50 to
100 ml for a 24-hour period of time. After CABG surgery chest tubes are typically
removed when drainage is less than 100 ml for eight hours.
✔✔You are caring for a patient with a chest tube in place for treatment of a
pneumothorax. What is true regarding the waterseal chamber:
A. The main purpose of the water seal is to allow air to exit from the pleural space on
exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation.
B. Lack of tidaling may indicate a kink.
C. Continuous bubbling represents an air leak.
D. The chamber may bubble gently during expiration.
E. All of the above. - ✔✔E. The 2nd compartment is connected to the 1st and creates a
water seal. A small amount of sterile water (per manufacturer directions) is injected into
the water seal chamber before the drainage system is connected to the patient. The
,main purpose of the water seal is to allow air to exit from the pleural space on
exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation.
Air that is allowed to pass through the water seal will bubble out the bottom of the
chamber. The water seal chamber is calibrated and should be seen as the window into
the pleural space. During gravity drainage the level of water reflects the intrapleural
pressure. Some newer systems eliminate the water seal chamber and use a check-
valve to serve its purpose.
Assure that the amount of sterile fluid in the water seal and suction chambers is at the
manufacturer recommended levels when wet systems are used. To maintain an
adequate water seal in a wet system it is important to monitor the level of water in the
water seal chamber and to keep the chest drainage unit upright at all times.
Assess for air leak by checking water seal chamber for bubbles during inspiration. The
water seal chamber may bubble gently with insertion, during expiration and with a
cough. Continuous bubbling represents an air leak. Some water seal compartments
have an air leak meter. Check for system leaks by clamping before each connection
(system may need to be replaced). Check for leak where tube enters chest. Check
chest x-ray to assure last hole of chest tube is inside chest.
Assess the water seal chamber for slight fluctuation. Slight fluctuation (tidaling) in the
water seal level (rising during spontaneous inspiration and falling during expiration) is
normal. Lack of fluctuation with respiration may indicate kinking or other problems
interferin
✔✔You are using a chest tube drainage system that requires fluid in the water seal
chamber. What is an important nursing consideration:
A. Assure that the amount of sterile fluid in the water seal and suction chambers is at
the manufacturer recommended level.
B. Assure that there is continuous bubbling in the water seal chamber.
C. Report any tidaling of this chamber immediately.
D. Invert the water seal system at least once every 4 hours. - ✔✔A. The 2nd
compartment is connected to the 1st and creates a water seal. A small amount of sterile
water (per manufacturer directions) is injected into the water seal chamber before the
drainage system is connected to the patient. The main purpose of the water seal is to
allow air to exit from the pleural space on exhalation and prevent air from entering the
pleural cavity or mediastinum on inhalation. Air that is allowed to pass through the water
seal will bubble out the bottom of the chamber. The water seal chamber is calibrated
and should be seen as the window into the pleural space. During gravity drainage the
level of water reflects the intrapleural pressure. Some newer systems eliminate the
water seal chamber and use a check-valve to serve its purpose.
Assure that the amount of sterile fluid in the water seal and suction chambers is at the
manufacturer recommended levels when wet systems are used. To maintain an
adequate water seal in a wet system it is important to monitor the level of water in the
water seal chamber and to keep the chest drainage unit upright at all times.
Assess for air leak by checking water seal chamber for bubbles during inspiration. The
water seal chamber may bubble gently with insertion, during expiration and with a
cough. Continuous bubbling represents an air leak. Some water seal compartments
have an air leak meter.
, ✔✔What is correct nursing knowledge regarding the chest tube drainage systems and
suction:
A. Wet suction units regulate the amount of suction by the suction from the wall unit and
not by the height of a column of water in the suction chamber.
B. Wet suction units regulate the amount of suction by the height of a column of water in
the suction chamber not by the suction from the wall unit.
C. Usually -80 cm H2O should be applied to a chest tube drainage system.
D. Robust bubbling is needed in order to have an adequate amount of suction. - ✔✔B.
The 3rd compartment of a chest drainage system is connected to the first two sections
and provides suction. There are two types of suction units: wet and dry. Wet suction
units regulate the amount of suction by the height of a column of water in the suction
chamber not by the suction from the wall unit. When a water column is used, only gentle
bubbling should occur in the suction chamber. The source of suction should be adjusted
to prevent loud bubbling of the water. Excessive external suction results in evacuation
of water from the control chamber. The system valve controls the amount of suction and
should normally be adjusted to achieve -20 cm H2O of suction. Lower levels of suction
may be indicated for patients with friable lung tissue. The goal is to have an adequate
amount of suction to keep open the pleural space, but not an excessive amount that will
cause damage to the lung tissue. No more than -40 cm H2O should be applied to a
chest tube drainage system. Many disposable chest tubes today have a dry suction
regulator. This means there is no water in the suction chamber. A mechanical regulator
within the unit is used to set the amount of suction applied to the system. The wall
vacuum regulator is set at minus 80 cmH2O but the regulator on the unit is set to limit
the suction to typically minus 20 cmH2O.
✔✔Which of the following is not an appropriate nursing intervention in caring for a
patient with a chest tube drainage system:
A. Clamping the chest tube after disconnecting suction in a patient leaving the unit for a
diagnostic test.
B. Reporting new diminished or any absence of lung sounds.
C. Reporting continuous bubbling in the waterseal chamber.
D. Performing gentle milking when drainage is present. - ✔✔A. Do not clamp chest tube
for transport (can cause tension pneumothorax with pleural chest tubes or tamponade
with mediastinal chest tubes). Use portable suction if available or transport on gravity
drainage with tubing from suction chamber open to air. Leaving the tubing open to air
allows a vent for the escape of air. If there is an order for suction and no portable
suction is available then obtain an order to transport with gravity drainage.
Maintaining patency is a key nursing intervention. Avoid dependent loops in the
drainage tubing. Chest tube should be gently milked if there is drainage, but there
should be no routine stripping. Aggressive stripping of a mediastinal chest tube can
result in a negative 300 cmH2O pressure in the mediastinum and can aggravate
bleeding.
Reportable conditions in patients with chest tubes include:
• Signs and symptoms of increased air leak (increased crepitus, bubbling in the water
seal chamber)
QUESTIONS AND ANSWERS SURE A+
✔✔In caring for a patient with chest tubes the nurse knows the following to be true
concerning drainage:
A. A patient with decreased breath sounds and increased inspiratory pressures on the
ventilator but with no drainage in the chest tube might have a collection of undrained
blood in the pleural space.
B. Dumping of blood into the chest tube with a position change is usually related to a
new bleed.
C. Chest tubes can safely be removed as long as the amount of drainage is < 500 ml
per 8 hours.
D. Aggressive stripping is necessary to keep the drainage tube patent. - ✔✔A. A
change in patient condition, such as decreased breath sounds and increased inspiratory
pressures on the ventilator alarm, may indicate blood in the pleural space that has not
been effectively drained by the chest tube.
Aggressive stripping of the chest tube can cause a negative pressure of over 300 cm of
H2O and this can cause further bleeding and is painful for the patient.
When a dumping of blood occurs with a position change this can represent either new
or old blood. The color of the blood as well as other changes in the patient condition can
be used to help assess the acuity of the bleeding.
Chest tubes are typically not removed until the amount of drainage is less than 50 to
100 ml for a 24-hour period of time. After CABG surgery chest tubes are typically
removed when drainage is less than 100 ml for eight hours.
✔✔You are caring for a patient with a chest tube in place for treatment of a
pneumothorax. What is true regarding the waterseal chamber:
A. The main purpose of the water seal is to allow air to exit from the pleural space on
exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation.
B. Lack of tidaling may indicate a kink.
C. Continuous bubbling represents an air leak.
D. The chamber may bubble gently during expiration.
E. All of the above. - ✔✔E. The 2nd compartment is connected to the 1st and creates a
water seal. A small amount of sterile water (per manufacturer directions) is injected into
the water seal chamber before the drainage system is connected to the patient. The
,main purpose of the water seal is to allow air to exit from the pleural space on
exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation.
Air that is allowed to pass through the water seal will bubble out the bottom of the
chamber. The water seal chamber is calibrated and should be seen as the window into
the pleural space. During gravity drainage the level of water reflects the intrapleural
pressure. Some newer systems eliminate the water seal chamber and use a check-
valve to serve its purpose.
Assure that the amount of sterile fluid in the water seal and suction chambers is at the
manufacturer recommended levels when wet systems are used. To maintain an
adequate water seal in a wet system it is important to monitor the level of water in the
water seal chamber and to keep the chest drainage unit upright at all times.
Assess for air leak by checking water seal chamber for bubbles during inspiration. The
water seal chamber may bubble gently with insertion, during expiration and with a
cough. Continuous bubbling represents an air leak. Some water seal compartments
have an air leak meter. Check for system leaks by clamping before each connection
(system may need to be replaced). Check for leak where tube enters chest. Check
chest x-ray to assure last hole of chest tube is inside chest.
Assess the water seal chamber for slight fluctuation. Slight fluctuation (tidaling) in the
water seal level (rising during spontaneous inspiration and falling during expiration) is
normal. Lack of fluctuation with respiration may indicate kinking or other problems
interferin
✔✔You are using a chest tube drainage system that requires fluid in the water seal
chamber. What is an important nursing consideration:
A. Assure that the amount of sterile fluid in the water seal and suction chambers is at
the manufacturer recommended level.
B. Assure that there is continuous bubbling in the water seal chamber.
C. Report any tidaling of this chamber immediately.
D. Invert the water seal system at least once every 4 hours. - ✔✔A. The 2nd
compartment is connected to the 1st and creates a water seal. A small amount of sterile
water (per manufacturer directions) is injected into the water seal chamber before the
drainage system is connected to the patient. The main purpose of the water seal is to
allow air to exit from the pleural space on exhalation and prevent air from entering the
pleural cavity or mediastinum on inhalation. Air that is allowed to pass through the water
seal will bubble out the bottom of the chamber. The water seal chamber is calibrated
and should be seen as the window into the pleural space. During gravity drainage the
level of water reflects the intrapleural pressure. Some newer systems eliminate the
water seal chamber and use a check-valve to serve its purpose.
Assure that the amount of sterile fluid in the water seal and suction chambers is at the
manufacturer recommended levels when wet systems are used. To maintain an
adequate water seal in a wet system it is important to monitor the level of water in the
water seal chamber and to keep the chest drainage unit upright at all times.
Assess for air leak by checking water seal chamber for bubbles during inspiration. The
water seal chamber may bubble gently with insertion, during expiration and with a
cough. Continuous bubbling represents an air leak. Some water seal compartments
have an air leak meter.
, ✔✔What is correct nursing knowledge regarding the chest tube drainage systems and
suction:
A. Wet suction units regulate the amount of suction by the suction from the wall unit and
not by the height of a column of water in the suction chamber.
B. Wet suction units regulate the amount of suction by the height of a column of water in
the suction chamber not by the suction from the wall unit.
C. Usually -80 cm H2O should be applied to a chest tube drainage system.
D. Robust bubbling is needed in order to have an adequate amount of suction. - ✔✔B.
The 3rd compartment of a chest drainage system is connected to the first two sections
and provides suction. There are two types of suction units: wet and dry. Wet suction
units regulate the amount of suction by the height of a column of water in the suction
chamber not by the suction from the wall unit. When a water column is used, only gentle
bubbling should occur in the suction chamber. The source of suction should be adjusted
to prevent loud bubbling of the water. Excessive external suction results in evacuation
of water from the control chamber. The system valve controls the amount of suction and
should normally be adjusted to achieve -20 cm H2O of suction. Lower levels of suction
may be indicated for patients with friable lung tissue. The goal is to have an adequate
amount of suction to keep open the pleural space, but not an excessive amount that will
cause damage to the lung tissue. No more than -40 cm H2O should be applied to a
chest tube drainage system. Many disposable chest tubes today have a dry suction
regulator. This means there is no water in the suction chamber. A mechanical regulator
within the unit is used to set the amount of suction applied to the system. The wall
vacuum regulator is set at minus 80 cmH2O but the regulator on the unit is set to limit
the suction to typically minus 20 cmH2O.
✔✔Which of the following is not an appropriate nursing intervention in caring for a
patient with a chest tube drainage system:
A. Clamping the chest tube after disconnecting suction in a patient leaving the unit for a
diagnostic test.
B. Reporting new diminished or any absence of lung sounds.
C. Reporting continuous bubbling in the waterseal chamber.
D. Performing gentle milking when drainage is present. - ✔✔A. Do not clamp chest tube
for transport (can cause tension pneumothorax with pleural chest tubes or tamponade
with mediastinal chest tubes). Use portable suction if available or transport on gravity
drainage with tubing from suction chamber open to air. Leaving the tubing open to air
allows a vent for the escape of air. If there is an order for suction and no portable
suction is available then obtain an order to transport with gravity drainage.
Maintaining patency is a key nursing intervention. Avoid dependent loops in the
drainage tubing. Chest tube should be gently milked if there is drainage, but there
should be no routine stripping. Aggressive stripping of a mediastinal chest tube can
result in a negative 300 cmH2O pressure in the mediastinum and can aggravate
bleeding.
Reportable conditions in patients with chest tubes include:
• Signs and symptoms of increased air leak (increased crepitus, bubbling in the water
seal chamber)
