CARDIAC SURGERY CSC STUDY EXAMS GUIDE
QUESTIONS AND ANSWERS SURE A+
✔✔You are caring for a 72 yr old female patient who is readmitted for left pleural
effusion three weeks after CABG surgery. On night shift she develops progressive
dyspnea. Assessment reveals the following: HR 110 (sinus tachycardia), BP 104/70
mmHg, and the systolic falls to 88 mmHg with inspiration. Her radial pulse becomes
weaker during inspiration. She has jugular venous distention, moderate peripheral
edema, distant heart sounds, fine inspiratory crackles left lower lobe. What emergency
situation must be ruled out based on these assessment findings:
A. Increase in left pleural effusion causing tension pneumothorax.
B. Spasm of a radial artery graft.
C. Closure of one of the saphenous vein grafts.
D. Cardiac tamponade. - ✔✔D. Cardiac tamponade is a cause of obstructive shock.
Signs and symptoms of tamponade include Beck's triad: hypotension, JVD, and muffled
heart sounds. Other signs include abnormal pulsus paradoxus, which is a drop in
systolic blood pressure during inspiration of > 12 mmHg and weak or absent pulses
during inspiration. A patient who is post open-heart surgery has the potential risk of
bleeding and development of tamponade.
A tension pneumothorax can compress the heart and great vessels and cause
obstructive shock and many of the same signs as cardiac tamponade. However, pleural
effusion does not cause tension pneumothorax. In addition there are fine inspiratory
crackles in the left low lobe, which is consistent with the admission diagnosis. Lung
sounds do not provide any evidence of worsening pleural effusion.
Closure of a saphenous vein graft or radial artery graft spasm would result in signs
consistent with myocardial ischemia or infarction. Neither of these two cases would
result in obstructive shock.
✔✔You are caring for a patient with a chest tube in place for treatment of a
pneumothorax. What is true regarding the waterseal chamber:
Continuous bubbling represents an air leak.
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. The chamber may bubble gently during expiration.
C. Lack of tidaling may indicate a kink.
,D. All of the above. - ✔✔D. 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. Report any tidaling of this chamber immediately.
B. Invert the water seal system at least once every 4 hours.
C. Assure that the amount of sterile fluid in the water seal and suction chambers is at
the manufacturer recommended level.
D. Assure that there is continuous bubbling in the water seal chamber. - ✔✔C. 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. Usually -80 cm H2O should be applied to a chest tube drainage system.
B. Robust bubbling is needed in order to have an adequate amount of suction.
C. 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.
D. 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. - ✔✔D. 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. Reporting continuous bubbling in the waterseal chamber.
B. Reporting new diminished or any absence of lung sounds.
C. Performing gentle milking when drainage is present.
D. Clamping the chest tube after disconnecting suction in a patient leaving the unit for a
diagnostic test. - ✔✔D. 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
QUESTIONS AND ANSWERS SURE A+
✔✔You are caring for a 72 yr old female patient who is readmitted for left pleural
effusion three weeks after CABG surgery. On night shift she develops progressive
dyspnea. Assessment reveals the following: HR 110 (sinus tachycardia), BP 104/70
mmHg, and the systolic falls to 88 mmHg with inspiration. Her radial pulse becomes
weaker during inspiration. She has jugular venous distention, moderate peripheral
edema, distant heart sounds, fine inspiratory crackles left lower lobe. What emergency
situation must be ruled out based on these assessment findings:
A. Increase in left pleural effusion causing tension pneumothorax.
B. Spasm of a radial artery graft.
C. Closure of one of the saphenous vein grafts.
D. Cardiac tamponade. - ✔✔D. Cardiac tamponade is a cause of obstructive shock.
Signs and symptoms of tamponade include Beck's triad: hypotension, JVD, and muffled
heart sounds. Other signs include abnormal pulsus paradoxus, which is a drop in
systolic blood pressure during inspiration of > 12 mmHg and weak or absent pulses
during inspiration. A patient who is post open-heart surgery has the potential risk of
bleeding and development of tamponade.
A tension pneumothorax can compress the heart and great vessels and cause
obstructive shock and many of the same signs as cardiac tamponade. However, pleural
effusion does not cause tension pneumothorax. In addition there are fine inspiratory
crackles in the left low lobe, which is consistent with the admission diagnosis. Lung
sounds do not provide any evidence of worsening pleural effusion.
Closure of a saphenous vein graft or radial artery graft spasm would result in signs
consistent with myocardial ischemia or infarction. Neither of these two cases would
result in obstructive shock.
✔✔You are caring for a patient with a chest tube in place for treatment of a
pneumothorax. What is true regarding the waterseal chamber:
Continuous bubbling represents an air leak.
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. The chamber may bubble gently during expiration.
C. Lack of tidaling may indicate a kink.
,D. All of the above. - ✔✔D. 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. Report any tidaling of this chamber immediately.
B. Invert the water seal system at least once every 4 hours.
C. Assure that the amount of sterile fluid in the water seal and suction chambers is at
the manufacturer recommended level.
D. Assure that there is continuous bubbling in the water seal chamber. - ✔✔C. 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. Usually -80 cm H2O should be applied to a chest tube drainage system.
B. Robust bubbling is needed in order to have an adequate amount of suction.
C. 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.
D. 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. - ✔✔D. 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. Reporting continuous bubbling in the waterseal chamber.
B. Reporting new diminished or any absence of lung sounds.
C. Performing gentle milking when drainage is present.
D. Clamping the chest tube after disconnecting suction in a patient leaving the unit for a
diagnostic test. - ✔✔D. 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
