ATI Chest Tube Care: Comprehensive
Examination
Questions Versionwell
2.0 written one year
2025 /2026 updated graded A+
Advanced
Clinical Assessment for Nursing Professionals
PART I: Foundational Concepts and Pathophysiology
Question 1
A nurse is caring for a client with a chest tube following a traumatic pneumothorax. The nurse
understands that the primary mechanism by which a chest tube promotes lung re-expansion is:
A. Creating positive pressure within the pleural space
B. Removing air and fluid to restore negative intrapleural pressure
C. Directly inflating the lung through the tube
D. Compressing the lung tissue to promote healing
- detailed answer 100 % correct :-B
Rationale: Chest tubes function by removing air, fluid, blood, or pus from the pleural space,
thereby restoring the normal negative intrapleural pressure. This negative pressure allows the
lung to re-expand and resume normal respiratory function. The tube does not create positive
pressure or directly inflate the lung.
Question 2
A client is diagnosed with a tension pneumothorax following a motor vehicle accident. The
nurse recognizes that this condition requires immediate intervention because:
A. The lung is completely collapsed and nonfunctional
B. The accumulation of air in the pleural space causes mediastinal shift and
compromisescardiac output
C. The client is at risk for developing a pulmonary embolism
,D. The condition will resolve spontaneously with oxygen therapy
- detailed answer 100 % correct :-B
Rationale: Tension pneumothorax occurs when air continues to enter the pleural space during
inspiration but cannot exit during expiration, causing progressive accumulation of air and a
one-way valve effect. This leads to increased intrapleural pressure, compression of the lung,
mediastinal shift to the contralateral side, decreased venous return, and ultimately
compromised cardiac output requiring immediate needle decompression or chest tube
insertion.
Question 3
A nurse is reviewing the physiological principles of chest tube drainage with a new graduate.
The nurse correctly states that normal intrapleural pressure during spontaneous inspiration is:
A. +4 cm H₂O
B. -4 cm H₂O
C. -8 cm H₂O
D. 0 cm H₂O
- detailed answer 100 % correct :-C
Rationale: Normal intrapleural pressure is approximately -8 cm H₂O during spontaneous
inspiration and -4 cm H₂O during expiration. This negative pressure is essential for maintaining
lung inflation and preventing atelectasis. The chest tube drainage system must maintain a
sufficient pressure gradient to promote drainage.
Question 4
A client with a history of congestive heart failure develops a large pleural effusion. The nurse
anticipates chest tube insertion primarily to: A. Prevent the development of pneumonia
B. Relieve dyspnea and improve oxygenation
C. Administer medications directly into the pleural space
D. Monitor intrapleural pressures continuously
- detailed answer 100 % correct :-B
Rationale: In clients with pleural effusion, chest tube insertion is primarily indicated to drain
accumulated fluid from the pleural space, thereby relieving compression of the lung and
improving respiratory function. This alleviates dyspnea and enhances oxygenation.
,Question 5
The nurse is caring for a client with a hemothorax following a thoracotomy. The chest tube was
placed to:
A. Administer blood products directly into the pleural space
B. Remove accumulated blood and prevent lung compression
C. Measure the amount of blood loss accurately
D. Provide a route for medication administration
- detailed answer 100 % correct :-B
Rationale: In hemothorax, blood accumulates in the pleural space, compressing the lung and
impairing ventilation. Chest tube insertion removes the blood, allows lung re-expansion, and
prevents complications such as fibrothorax and empyema.
Question 6
A nurse is preparing a client for chest tube insertion due to a spontaneous pneumothorax. The
client asks why a chest tube is necessary if the pneumothorax is small. The nurse's best
response is:
A. "The tube will prevent the pneumothorax from recurring"
B. "Even a small pneumothorax can progress and cause respiratory compromise"
C. "The tube is needed to administer oxygen directly to the lung"
D. "The tube will help us monitor your breathing more accurately"
- detailed answer 100 % correct :-B
Rationale: Even small pneumothoraces can progress to larger pneumothoraces or tension
pneumothorax. Chest tube insertion may be indicated to evacuate the air and prevent
progression of the condition, especially in clients with underlying lung disease or those who
require positive pressure ventilation.
Question 7
The nurse is caring for a client who developed a chylothorax following a thoracic surgical
procedure. The nurse understands that chylothorax involves the accumulation of:
A. Blood in the pleural space
B. Lymphatic fluid in the pleural space
C. Pus in the pleural space
, D. Serous fluid in the pleural space
- detailed answer 100 % correct :-B
Rationale: Chylothorax is the accumulation of chyle, a milky lymphatic fluid, in the pleural
space. This typically results from damage to the thoracic duct during thoracic surgery or
trauma. The chyle is rich in triglycerides and lymphocytes.
Question 8
A nurse is assessing a client who sustained a stab wound to the chest. The client has absent
breath sounds on the left side and tracheal deviation to the right. The nurse should anticipate:
A. Administering supplemental oxygen only
B. Preparing for immediate chest tube insertion
C. Applying a three-sided occlusive dressing
D. Positioning the client on the right side
- detailed answer 100 % correct :-B
Rationale: Absent breath sounds on the affected side with tracheal deviation to the
contralateral side indicates a tension pneumothorax, which requires immediate needle
decompression followed by chest tube insertion. This is a life-threatening emergency.
Question 9
The nurse is caring for a client with a chest tube who has a known allergy to latex. Which
intervention is most important for this client?
A. Administering antihistamines prophylactically
B. Ensuring that all supplies used are latex-free
C. Monitoring for signs of anaphylaxis
D. Documenting the allergy in the medical record
- detailed answer 100 % correct :-B
Rationale: For clients with a latex allergy, it is essential to ensure that all supplies (including
chest tube, drainage system components, dressings, and gloves) are latex-free. Preventing
exposure to latex is the priority intervention.
Examination
Questions Versionwell
2.0 written one year
2025 /2026 updated graded A+
Advanced
Clinical Assessment for Nursing Professionals
PART I: Foundational Concepts and Pathophysiology
Question 1
A nurse is caring for a client with a chest tube following a traumatic pneumothorax. The nurse
understands that the primary mechanism by which a chest tube promotes lung re-expansion is:
A. Creating positive pressure within the pleural space
B. Removing air and fluid to restore negative intrapleural pressure
C. Directly inflating the lung through the tube
D. Compressing the lung tissue to promote healing
- detailed answer 100 % correct :-B
Rationale: Chest tubes function by removing air, fluid, blood, or pus from the pleural space,
thereby restoring the normal negative intrapleural pressure. This negative pressure allows the
lung to re-expand and resume normal respiratory function. The tube does not create positive
pressure or directly inflate the lung.
Question 2
A client is diagnosed with a tension pneumothorax following a motor vehicle accident. The
nurse recognizes that this condition requires immediate intervention because:
A. The lung is completely collapsed and nonfunctional
B. The accumulation of air in the pleural space causes mediastinal shift and
compromisescardiac output
C. The client is at risk for developing a pulmonary embolism
,D. The condition will resolve spontaneously with oxygen therapy
- detailed answer 100 % correct :-B
Rationale: Tension pneumothorax occurs when air continues to enter the pleural space during
inspiration but cannot exit during expiration, causing progressive accumulation of air and a
one-way valve effect. This leads to increased intrapleural pressure, compression of the lung,
mediastinal shift to the contralateral side, decreased venous return, and ultimately
compromised cardiac output requiring immediate needle decompression or chest tube
insertion.
Question 3
A nurse is reviewing the physiological principles of chest tube drainage with a new graduate.
The nurse correctly states that normal intrapleural pressure during spontaneous inspiration is:
A. +4 cm H₂O
B. -4 cm H₂O
C. -8 cm H₂O
D. 0 cm H₂O
- detailed answer 100 % correct :-C
Rationale: Normal intrapleural pressure is approximately -8 cm H₂O during spontaneous
inspiration and -4 cm H₂O during expiration. This negative pressure is essential for maintaining
lung inflation and preventing atelectasis. The chest tube drainage system must maintain a
sufficient pressure gradient to promote drainage.
Question 4
A client with a history of congestive heart failure develops a large pleural effusion. The nurse
anticipates chest tube insertion primarily to: A. Prevent the development of pneumonia
B. Relieve dyspnea and improve oxygenation
C. Administer medications directly into the pleural space
D. Monitor intrapleural pressures continuously
- detailed answer 100 % correct :-B
Rationale: In clients with pleural effusion, chest tube insertion is primarily indicated to drain
accumulated fluid from the pleural space, thereby relieving compression of the lung and
improving respiratory function. This alleviates dyspnea and enhances oxygenation.
,Question 5
The nurse is caring for a client with a hemothorax following a thoracotomy. The chest tube was
placed to:
A. Administer blood products directly into the pleural space
B. Remove accumulated blood and prevent lung compression
C. Measure the amount of blood loss accurately
D. Provide a route for medication administration
- detailed answer 100 % correct :-B
Rationale: In hemothorax, blood accumulates in the pleural space, compressing the lung and
impairing ventilation. Chest tube insertion removes the blood, allows lung re-expansion, and
prevents complications such as fibrothorax and empyema.
Question 6
A nurse is preparing a client for chest tube insertion due to a spontaneous pneumothorax. The
client asks why a chest tube is necessary if the pneumothorax is small. The nurse's best
response is:
A. "The tube will prevent the pneumothorax from recurring"
B. "Even a small pneumothorax can progress and cause respiratory compromise"
C. "The tube is needed to administer oxygen directly to the lung"
D. "The tube will help us monitor your breathing more accurately"
- detailed answer 100 % correct :-B
Rationale: Even small pneumothoraces can progress to larger pneumothoraces or tension
pneumothorax. Chest tube insertion may be indicated to evacuate the air and prevent
progression of the condition, especially in clients with underlying lung disease or those who
require positive pressure ventilation.
Question 7
The nurse is caring for a client who developed a chylothorax following a thoracic surgical
procedure. The nurse understands that chylothorax involves the accumulation of:
A. Blood in the pleural space
B. Lymphatic fluid in the pleural space
C. Pus in the pleural space
, D. Serous fluid in the pleural space
- detailed answer 100 % correct :-B
Rationale: Chylothorax is the accumulation of chyle, a milky lymphatic fluid, in the pleural
space. This typically results from damage to the thoracic duct during thoracic surgery or
trauma. The chyle is rich in triglycerides and lymphocytes.
Question 8
A nurse is assessing a client who sustained a stab wound to the chest. The client has absent
breath sounds on the left side and tracheal deviation to the right. The nurse should anticipate:
A. Administering supplemental oxygen only
B. Preparing for immediate chest tube insertion
C. Applying a three-sided occlusive dressing
D. Positioning the client on the right side
- detailed answer 100 % correct :-B
Rationale: Absent breath sounds on the affected side with tracheal deviation to the
contralateral side indicates a tension pneumothorax, which requires immediate needle
decompression followed by chest tube insertion. This is a life-threatening emergency.
Question 9
The nurse is caring for a client with a chest tube who has a known allergy to latex. Which
intervention is most important for this client?
A. Administering antihistamines prophylactically
B. Ensuring that all supplies used are latex-free
C. Monitoring for signs of anaphylaxis
D. Documenting the allergy in the medical record
- detailed answer 100 % correct :-B
Rationale: For clients with a latex allergy, it is essential to ensure that all supplies (including
chest tube, drainage system components, dressings, and gloves) are latex-free. Preventing
exposure to latex is the priority intervention.
