Chapter 26: Closed Chest Drainage Systems

MULTIPLE CHOICE 1. The nurse is caring for a patient who is comatose and on a ventilator. When she enters the room, she notices that the patient’s trachea has shifted toward the left side of the patient’s neck, and he has become tachycardic. She assesses the patient’s blood pressure and notes that it is 84/38. The nurse calls for help, having recognized that the patient has developed which of the following conditions? a. Hemothorax b. Pneumothorax on the left side c. Pneumothorax on the right side d. Myocardial infarction ANS: C A tension pneumothorax occurs from rupture in the pleura when air accumulates in the pleural space more rapidly than it is removed. If left untreated, the lung on the affected side collapses, and the mediastinum and the trachea shift to the opposite (unaffected) side. The patient has sudden chest pain, a fall in blood pressure, and tachycardia, and cardiopulmonary arrest can occur. Patients with chest trauma, fractured ribs, and invasive thoracic bedside procedures (such as insertion of central lines) and those on high-pressure mechanical ventilation are at risk for tension pneumothorax. A hemothorax is a collapse of the lung caused by an accumulation of blood and fluid in the pleural cavity between the chest wall and the lung, usually as a result of trauma. Nothing in this scenario would suggest myocardial infa DIF: Cognitive Level: Synthesis REF: Text reference: p. 656 OBJ: List three conditions requiring chest tube insertion. TOP: Pneumothorax KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. For a patient with a pneumothorax, where does the nurse anticipate that the chest tube will be located? a. Second to third intercostal space (apical), anterior b. Fifth to sixth intercostal space, posterior c. Fifth to sixth intercostal space, lateral d. Mediastinal area ANS: A Apical (second or third intercostal space) and anterior chest tube placement promotes removal of air, which is necessary in the case of a pneumothorax. Chest tubes are placed low (usually in the fifth or sixth intercostal space) and posterior or lateral to drain fluid. A mediastinal chest tube is placed in the mediastinum, just below the sternum. This tube drains blood or fluid, preventing its accumulation around the heart. A mediastinal tube commonly is used after open heart surgery. DIF: Cognitive Level: Analysis REF: Text reference: p. 656 OBJ: List three common sites for chest tube placement. TOP: Chest Tube Position KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity