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Exam (elaborations)

Chest Tubes Questions And Answers 2022

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Chest Tubes Questions And Answers 2022 A nurse is preparing to care for a client following chest tube placement. Which of the following items should be available in the client's room? (Select all that apply.) A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing - ANS-A, B, C, E Oxygen should be readily available in case the client develops respiratory distress following chest tube placement. The nurse should monitor respiration, oxygen saturation, and lung sounds. If the chest tubing becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal. Hemostat clamps should be available for the nurse to use to check for air leaks. If the chest tubing becomes disconnected, the nurse should immediately place a gauze dressing over the site. An occlusive dressing can also be necessary to prevent the redevelopment of a pneumothorax. 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. - ANS-B. Using the airway, breathing, and circulation (ABC) priority-setting framework, application of a sterile gauze to the site should be the first action for the nurse to take. This allows air to escape and reduces the risk for development of a tension pneumothorax. 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 - ANS-B, C Gentle bubbling in the suction control chamber is an expected finding as air is being removed. A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicates that the drainage system is functioning properly. A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do? A. Lie on his left side. B. Use the incentive spirometer. C. Cough at regular intervals. D. Perform the Valsalva maneuver. - ANS-D The client should be instructed to take a deep breath, exhale, and bear down (Valsalva maneuver) as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism. 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 every 2 hr. B. Check for continuous bubbling in the suction chamber. C. Strip the drainage tubing every 4 hr. D. Clamp the tube once a day. E. Obtain a chest x-ray. - ANS-A, B, E The nurse should instruct the client to cough every 2 hr. This promotes oxygenation and lung reexpansion. The nurse should check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level. A chest x-ray is obtained following the procedure to verify chest tube placement The nurse is observing a patient's chest tube drainage system and notes that there is movement of fluid in the water seal chamber. What does this nurse recognize this as? - ANS-The nurse recognizes this as tidaling, which is an expected finding. The fluid moves within the water seal chamber in conjunction with respiration. A patient just underwent open-heart surgery. The nurse should expect placement of a chest tube at which level and for which indication? - ANS-The chest tube will be placed between the 5th and 6th intercostal space for drainage of blood and fluids. Upon assessment of a newly admitted patient, the nurse notes hyperresonance on percussion of the chest, along with dyspnea and absent breath sounds on one side. The nurse knows that this finding is indicative of which diagnosis? - ANSPneumothorax Upon assessment of a newly admitted patient, the nurse notes dullness on percussion of the chest, along with dyspnea and pleuritic chest pain. The nurse knows that this finding is indicative of which diagnosis? - ANS-Hemothorax While the patient is ambulating, the chest tube drainage system should be above the client's chest level. True or False? - ANS-False. The chest tube drainage system should be below the patient's chest level at all times, even when ambulating. A new grad nurse is caring for a client with a chest tube and drainage system. While performing her routine assessment and safety checks, the nurse knows that which items should be at the bedside at all times? (Select all that apply) A) Occlusive dressing B) Enclosed hemostats C) Normal saline D) Oxygen E) Irrigation syringe - ANS-A, B, D CONTINUES...

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October 16, 2022
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2022/2023
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