Nclexpn Quiz: Chest Tube And Drainage Device Care

What this quiz covers

This quiz focuses on Chest Tube And Drainage Device Care, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexpn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Oxygen saturation is 92% on 2 L/min nasal cannula
2. Drainage has increased to 220 mL in the last hour and is bright red (correct answer)
3. Heart rate is 102/min and respiratory rate is 22/min
4. Temperature is 98.9°F (37.2°C) and blood pressure is 118/72 mm Hg

Explanation: This question tests clinical judgment in recognizing hemorrhage as a post-thoracotomy complication requiring immediate intervention. The priority concern is active bleeding indicated by the sudden increase to 220 mL/hr of bright red drainage, which suggests arterial bleeding or major vessel injury. Reporting the increased bright red drainage (B) is correct because this volume and appearance indicate hemorrhage requiring immediate medical evaluation and possible return to surgery. Oxygen saturation of 92% (A) is slightly low but not immediately life-threatening, elevated vital signs (C) are expected post-operatively and with mild hypoxemia, and the temperature and blood pressure (D) are within normal limits. The decision-making principle is recognizing drainage patterns that indicate hemorrhage versus expected post-operative drainage. When monitoring post-thoracotomy drainage, immediately report outputs exceeding 100 mL/hr after the first 2 hours, sudden increases in drainage, or color changes to bright red.

Question 2

1. Continuous gentle bubbling is present in the suction-control chamber when suction is on
2. The drainage is straw-colored and the collection chamber is kept below chest level
3. 900 mL of drainage has collected during the first hour after insertion (correct answer)
4. Breath sounds are diminished at the right base but present in the upper lobe

Explanation: This question tests clinical judgment in recognizing excessive chest tube drainage requiring immediate intervention. The priority concern is hemorrhage or rapid fluid loss, as 900 mL in the first hour far exceeds the normal expected drainage of 100-300 mL/hr initially. Reporting this finding immediately (C) is correct because excessive drainage can lead to hypovolemic shock and requires urgent medical evaluation and possible surgical intervention. Gentle bubbling in the suction chamber (A) is normal when suction is applied, straw-colored drainage below chest level (B) indicates proper positioning and expected drainage characteristics, and diminished breath sounds at the base (D) are expected with pleural effusion. The decision-making principle is recognizing abnormal drainage volumes that indicate potential hemorrhage or rapid fluid shifts. When monitoring chest tube output, immediately report drainage exceeding 100 mL/hr after the first 2 hours or any sudden increase in bloody drainage.

Question 3

1. Continuous, vigorous bubbling.
2. Fluctuation of the water level with respirations. (correct answer)
3. Absence of any movement in the water level.
4. The water level is at the top of the chamber.

Explanation: The correct answer is B. Fluctuation of the water level with respirations, known as tidaling, is an expected finding that indicates the chest tube is patent and functioning properly. A: Continuous bubbling indicates an air leak in the system or from the client. C: Absence of tidaling may indicate that the lung has re-expanded (a desired outcome) or that there is a kink or obstruction in the tubing. D: A high water level is not a specific expected finding and does not indicate proper function.

Question 4

1. Notify the registered nurse (RN) immediately.
2. Lift and drain the tubing content into the collection chamber. (correct answer)
3. Increase the level of wall suction.
4. Document the finding in the client's chart.

Explanation: The correct answer is B. Dependent loops can collect fluid and obstruct the flow of drainage from the pleural space, which can impede lung re-expansion. The priority action is to lift the tubing to allow the fluid to drain into the collection chamber, ensuring the system remains patent. A: Notifying the RN is not the priority; this is a situation the LPN can and should correct. C: Increasing suction will not resolve the obstruction caused by the fluid-filled loop. D: Documentation is necessary, but correcting the problem is the immediate priority.

Question 5

1. Document the drainage amount and continue to monitor.
2. Check the client's vital signs. (correct answer)
3. Reposition the client on the affected side.
4. Administer the prescribed analgesic.

Explanation: The correct answer is B. Drainage of more than 100-150 mL/hour of bright red blood, especially after the initial post-operative period, can indicate active bleeding or hemorrhage. The first action is to collect further data, specifically vital signs, to assess for signs of hemodynamic instability (e.g., hypotension, tachycardia). After gathering this critical data, the nurse must immediately report all findings to the RN as this is an abnormal finding requiring immediate attention. A: Simply documenting is unsafe as this finding is abnormal and requires immediate reporting. C: Repositioning does not address the potential for hemorrhage. D: Administering pain medication is not the priority when hemorrhage is suspected.

Question 6

1. Place the end of the chest tube in a bottle of sterile water. (correct answer)
2. Clamp the chest tube as close to the client's chest as possible.
3. Immediately reconnect the tube to the drainage system.
4. Cover the end of the tube with a sterile gauze pad.

Explanation: The correct answer is A. If the chest tube disconnects from the drainage system, the immediate action is to place the end of the tube in a bottle of sterile water or saline. This creates a temporary water seal, which prevents air from entering the pleural space while a new drainage system is prepared. B: Clamping the tube is dangerous and can lead to a tension pneumothorax. C: Reconnecting a contaminated tube introduces pathogens into the pleural space. D: Covering with sterile gauze does not create the necessary water seal to prevent air entry.

Question 7

1. The client's lung has fully re-expanded.
2. The suction level is set too high.
3. There is a leak in the drainage system. (correct answer)
4. The chest tube is clogged with a blood clot.

Explanation: The correct answer is C. Continuous bubbling in the water seal chamber indicates a persistent air leak. Since the tube was placed three days ago, the leak should be resolving. Continuous bubbling suggests a new or ongoing leak, which could be from the client or, more commonly, from a loose connection in the system. A: If the lung had re-expanded, tidaling and bubbling would cease. B: Suction level affects the suction control chamber, not the water seal chamber. D: A clot would cause tidaling to stop but would not cause bubbling.

Question 8

1. Apply a warm compress to the area.
2. Mark the area with a skin marker and notify the RN. (correct answer)
3. Reinforce the dressing with additional tape.
4. Document the finding as a normal variation.

Explanation: The correct answer is B. The crackling sensation is subcutaneous emphysema (crepitus), which occurs when air leaks from the pleural space into the subcutaneous tissues. The LPN should mark the outer border of the affected area to monitor for any increase in size and immediately notify the RN. This finding can indicate a worsening air leak or a malpositioned tube. A and C do not address the underlying problem. D is incorrect; this is an abnormal finding that requires monitoring and reporting.

Question 9

1. Check the tubing for any kinks or obstructions. (correct answer)
2. Administer oxygen via nasal cannula.
3. Notify the RN immediately.
4. Prepare for re-insertion of a new chest tube.

Explanation: The correct answer is A. The cessation of tidaling (fluctuation) combined with respiratory distress suggests an obstruction in the chest tube system. The first action is to quickly assess for and correct any common, reversible causes, such as kinks in the tubing or the client lying on the tube. This simple intervention may resolve the issue immediately. After checking the tubing, the nurse should notify the RN of the findings and the client's respiratory distress. B may be appropriate but does not address the potential cause. C should be done after the quick assessment. D is beyond the LPN's scope and premature.

Question 10

1. Vigorous and constant bubbling in the suction control chamber.
2. The water level in the suction control chamber is at the 20 cm mark. (correct answer)
3. The water seal chamber is completely filled with water.
4. The wall suction regulator is set to -80 mm Hg.

Explanation: The correct answer is B. In a wet suction system, the amount of suction is determined by the height of the water column in the suction control chamber, not by the setting on the wall regulator. The provider ordered -20 cm H2O, so the water level should be at the 20 cm mark. Gentle, not vigorous (A), bubbling in this chamber indicates that suction is active. C is incorrect; the water seal chamber is filled only to the indicated line. D is incorrect because the wall suction should be set high enough to produce gentle bubbling, but the wall setting itself does not determine the pressure applied to the client's chest.

Question 11

1. Maintaining the client on strict bed rest.
2. Encouraging the client to use the incentive spirometer every hour while awake. (correct answer)
3. Positioning the client on the unaffected side for 24 hours.
4. Restricting fluid intake to prevent fluid overload.

Explanation: The correct answer is B. Using an incentive spirometer, along with deep breathing and coughing exercises, helps to increase lung volume, prevent atelectasis, and promote the re-expansion of the affected lung. This is a critical component of care for any client with a chest tube. A: Ambulation and position changes are encouraged to promote drainage and lung expansion. C: Frequent position changes are needed. D: Fluid restriction is not indicated unless there is a co-existing condition like heart failure.

Question 12

1. Attempt to reinsert the chest tube into the opening.
2. Place a sterile glove over the insertion site.
3. Apply a sterile occlusive dressing taped on three sides. (correct answer)
4. Assess the client's breath sounds with a stethoscope.

Explanation: The correct answer is C. If a chest tube is accidentally removed, the immediate priority is to prevent air from entering the pleural space. The nurse should cover the site with a sterile occlusive dressing (such as petroleum gauze) and tape it on three sides. This creates a flutter valve effect, allowing air to escape from the pleural space on exhalation but preventing air from entering on inhalation. A is outside the LPN scope and can cause injury. B is not an adequate seal. D is an important assessment, but it should be done after the site is covered to prevent further complications.

Question 13

1. Observe for gentle bubbling in the water seal chamber.
2. Ensure the wall suction is set to a low, continuous level.
3. Check that the dial on the drainage device is set to 20. (correct answer)
4. Listen for a whistling sound coming from the device.

Explanation: The correct answer is C. In a dry suction system, the amount of suction is controlled by a regulator dial on the device itself. The nurse confirms the correct suction level by ensuring this dial is set to the prescribed level, which is -20 cm H2O in this case. A: Bubbling in the water seal chamber indicates an air leak, not the level of suction. B: The wall suction must be turned on, but the setting on the wall unit does not regulate the pressure applied to the client; the device itself does. An orange float or other indicator will confirm suction is active.

Question 14

1. Notify the RN of a potential hemorrhage.
2. Milk the chest tube tubing to improve drainage.
3. Record the 25 mL of output on the intake and output record. (correct answer)
4. Request an order for a STAT chest x-ray.

Explanation: The correct answer is C. A total of 25 mL of serosanguineous drainage over 3 hours (about 8 mL/hour) is a small and expected amount of drainage. The appropriate action is to document this normal finding. A: This amount does not suggest hemorrhage. B: Milking or stripping tubes is not routinely recommended as it can create dangerously high negative pressure. D: There is no indication for a STAT chest x-ray based on this finding.

Question 15

1. Keep a clamp at the bedside at all times.
2. Secure the drainage tubing to the client's gown and bed linen. (correct answer)
3. Administer a sedative medication to the client.
4. Ask a family member to stay with the client constantly.

Explanation: The correct answer is B. Securing the tubing to the gown (allowing slack for movement) and then to the bed linen helps prevent the client from accidentally dislodging the tube if they pull on it. This simple intervention adds a layer of safety. A: Clamps are kept at the bedside for emergencies like system changes or disconnection, but clamping a tube in a confused client who might have an air leak is dangerous. C: Administering a sedative may be necessary, but it is not a direct safety measure for the tube itself and requires an order. D: While helpful, relying on family is not a guaranteed nursing safety intervention.

Question 16

1. Cessation of drainage and client's report of dyspnea. (correct answer)
2. Pain level of 4 out of 10 at the insertion site.
3. Presence of tidaling in the water seal chamber.
4. Small amount of serous drainage on the dressing.

Explanation: The correct answer is A. The sudden cessation of drainage, especially when coupled with respiratory distress, is a significant finding that may indicate a blockage or clot in the tubing. This prevents air or fluid from escaping the pleural space, potentially leading to a tension pneumothorax. This is the most critical finding and must be reported immediately. B, C, and D represent expected or less urgent findings.

Question 17

1. Assessing the chest tube insertion site for signs of infection.
2. Measuring and recording the amount of drainage in the collection chamber.
3. Assisting the client with repositioning in bed. (correct answer)
4. Monitoring for bubbling in the water seal chamber.

Explanation: The correct answer is C. The UAP's scope of practice includes assisting with activities of daily living, such as repositioning. The LPN should instruct the UAP on how to move the client safely without dislodging or kinking the chest tube. A, B, and D are all assessment and monitoring tasks that require the knowledge and skill of a licensed nurse (LPN or RN) and cannot be delegated to a UAP.

Question 18

1. Maintain adequate oxygenation and ventilation. (correct answer)
2. Ensure the client remains free from anxiety.
3. Promote complete healing of the surgical incision.
4. Prevent the development of a deep vein thrombosis.

Explanation: The correct answer is A. The primary purpose of a chest tube after a thoracotomy is to drain fluid and air from the pleural space to allow the lung to fully re-expand. Therefore, the priority physiological goal is to maintain a patent airway, adequate breathing, and circulation (the ABCs). All other goals (B, C, D) are relevant but are secondary to the immediate priority of ensuring adequate respiratory function.

Question 19

1. Tap water.
2. Sterile water. (correct answer)
3. Hydrogen peroxide.
4. Povidone-iodine solution.

Explanation: The correct answer is B. The water seal chamber of a chest drainage unit should be filled with sterile water to prevent introducing microorganisms into the system and to ensure proper function. While some facilities may use tap water, sterile water is the preferred standard. Hydrogen peroxide and povidone-iodine are antiseptics and are not appropriate for this purpose.

Question 20

1. The client's current vital signs.
2. The amount of suction applied to the system. (correct answer)
3. The client's activity level during the shift.
4. The date and time of the last dressing change.

Explanation: The correct answer is B. Complete chest tube documentation must include the suction level being applied to the drainage system, as this is essential information for evaluating proper system function and ensuring continuity of care. The suction setting is a critical component that affects drainage effectiveness and must be documented with each assessment. While vital signs are important, they may be documented separately in the vital signs record.