chest trauma – Flashcards
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A 5-year-old child is returned to the pediatric intensive care unit after cardiac surgery. The child has a left chest tube attached to water-seal drainage, an intravenous line running of D5½NS at 4 mL/hr, and a double-lumen nasogastric tube connected to continuous suction. A cardiac monitor is in place, as is a dressing on the left side of the chest dressing. What is the priority nursing intervention? 1Auscultating breath sounds 2Testing the level of consciousness 3Measuring drainage from both tubes 4Determining the suction pressure of the nasogastric tube
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1Auscultating breath sounds
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An infant who underwent open repair of a fractured sternum now has a chest tube. What should the nurse explain to the parents concerning the chest tube? The infant will not feel any discomfort. It is inserted to drain the chest cavity of air. The tube has been inserted in case of an emergency. It will be removed when the infant tolerates feedings.
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It is inserted to drain the chest cavity of air.
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A client is admitted to the postanesthesia care unit after a segmental resection of the right lower lobe of the lung. A chest tube drainage system is in place. When caring for this tube, what should the nurse do? Raise the drainage system to bed level and check its patency. Clamp the tube when moving the client from the bed to a chair. Mark the time and fluid level on the side of the drainage chamber. Secure the chest catheter to the wound dressing with a sterile safety pin
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Mark the time and fluid level on the side of the drainage chamber
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A client has a chest tube for a pneumothorax. The nurse finds the client in respiratory difficulty, with the chest tube separated from the drainage system. What should the nurse do? Obtain a new sterile drainage system. Use two clamps to close the drainage tube. Place the client in the high-Fowler position. Reconnect the client's tube to the drainage system.
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Reconnect the client's tube to the drainage system.
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The parents of a child who is scheduled for open-heart surgery ask why their child must be subjected to chest tubes after surgery. What should the nurse consider before responding in language that the parents will understand? They will increase tidal volume. Drainage of air and fluid will be facilitated. They will maintain positive intrapleural pressure. Pressure on the pericardium and chest wall will be regulated
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Drainage of air and fluid will be facilitated.
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A client has chest tubes attached to a chest tube drainage system. What should the nurse do when caring for this client? Clamp the chest tubes when suctioning. Palpate the surrounding area for crepitus. Change the dressing daily using aseptic technique. Empty the drainage chamber at the end of the shift.
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Palpate the surrounding area for crepitus.
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A chest tube is inserted into a client who was stabbed in the chest and is attached to a closed-drainage system. Which is an important nursing intervention when caring for this client? Observe for fluid fluctuations in the water-seal chamber. Obtain a prescription for morphine to minimize agitation. Apply a thoracic binder to prevent excessive tension on the tube. Clamp the tubing securely to prevent a rapid decline in pressure.
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Observe for fluid fluctuations in the water-seal chamber.
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During the first 24 hours after open-heart surgery, serosanguineous fluid drains from the client's chest tube. How much drainage should the nurse expect during this period? 100 to 300 mL 400 to 500 mL 750 to 900 mL 800 to 1000 mL
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400 to 500 mL
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During the first 36 hours after the insertion of chest tubes, when assessing the function of a three-chamber, closed-chest drainage system, the nurse identifies that the water in the underwater seal tube is not fluctuating. What initial action should the nurse take? Take the client's vital signs. Inform the health care provider. Turn the client to the unaffected side. Check the tube to ensure that it is not kinked.
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Check the tube to ensure that it is not kinked.
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A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish? Remove the air that is present in the intrapleural space Drain serosanguinous fluid from the intrapleural compartment Permit the development of positive pressure between the layers of the pleura Provide access for the instillation of medication into the pleural space
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Remove the air that is present in the intrapleural space
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A nurse is caring for a client with a pneumothorax that has a chest tube attached to a closed chest drainage system. If the chest tube and closed-chest drainage system are effective, the type of pressure that will be reestablished is: Neutral pressure in the pleural space Negative pressure in the pleural space Atmospheric pressure in the thoracic cavity Intrapulmonic pressure in the thoracic cavity
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Negative pressure in the pleural space
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The nurse is caring for a client after the client's open heart surgery (CABG). Serosanguineous fluid drains from the client's chest tube. The nurse expects what volume of drainage from the tube during the first 24 hours after the surgery? 100 to 300 mL 400 to 500 mL 750 to 900 mL 800 to 1000 mL
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400 to 500 mL
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A client who sustained trauma to the chest as a result of an injury has chest tubes inserted and is attached to a closed-chest drainage system. When caring for this client, the nurse should: Palpate the area around the tubes for crepitus Clamp the chest tubes when suctioning the client Empty the drainage chamber at the end of the shift Change the client's dressing daily using aseptic technique
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Palpate the area around the tubes for crepitus
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To evaluate the effectiveness of a chest tube inserted in a client with a pneumothorax, the nurse assesses for: Productive coughing Return of breath sounds Increased pleural drainage in the chamber Constant bubbling in the water-seal chamber
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Return of breath sounds
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A client with a spontaneous pneumothorax asks, "Why did they put this tube into my chest?" The nurse explains that the purpose of the chest tube is to: Check for bleeding in the lung Monitor the function of the lung Drain fluid from the pleural space Remove air from the pleural space
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Remove air from the pleural space
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The nurse is providing postoperative care to a client with cancer of the lung that had a lobectomy. The client has a chest tube attached to suction. Which assessment finding includes a complication? Clots in the tubing during the first postoperative day Bloody fluid in the drainage-collection chamber on the first postoperative day Subcutaneous emphysema on the second postoperative day Decreased bubbling in the water-seal chamber on the third postoperative day
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Subcutaneous emphysema on the second postoperative day
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A client has a chest tube inserted to treat a right hemopneumothorax. In which position should the nurse place the client to facilitate chest drainage? Supine Left Sims Immobilized Right side-lying
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Right side-lying
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A nurse is providing immediate postoperative care to a client that had a lung resection for a malignancy. The client has a closed chest tube drainage system connected to suction. Which assessment finding requires additional evaluation by the nurse? A column of water 20 cm high in the suction control chamber 75 mL of bright red blood in the drainage collection chamber An intact occlusive dressing at the insertion site Constant bubbling in the water seal chamber
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Constant bubbling in the water seal chamber
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A client tells the nurse that the client's chest tube is scheduled to be removed soon. Before it is removed, the nurse is aware that: The drainage system will be disconnected from the chest tube. A chest x-ray will be performed to determine lung re-expansion. An arterial blood gas will be obtained to determine oxygenation status. The client will be sedated 30 minutes before the procedure.
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A chest x-ray will be performed to determine lung re-expansion.
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The primary responsibility of a nurse when caring for a client with a chest tube attached to a three-chamber underwater-seal drainage system is to: Ensure maintenance of the closed system Maintain mechanical suction to the system Encourage the client to deep breathe and cough Keep the client in the dorsal recumbent position
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Ensure maintenance of the closed system
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A client's chest tube has accidentally dislodged. What is the nursing action of highest priority? Place the client in a left side-lying position. Apply oxygen via non-rebreather mask. Apply a petroleum gauze dressing over the site. Prepare to reinsert a new chest tube
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Apply a petroleum gauze dressing over the site.
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The nurse is developing a plan of care for a client that had a chest tube removed. To promote respiratory exchange, the plan should include: Careful monitoring for crepitus Coughing and deep breathing every hour Bed rest with range-of-motion exercises Covering the chest tube site with a sterile dressing
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Coughing and deep breathing every hour
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A client has a chest tube for a pneumothorax. The nurse discovers that the chest tube has become disconnected from the drainage system, and the client is experiencing respiratory difficulty. What initial action should the nurse take? Obtain a new sterile drainage system Use two padded hemostats to clamp the drainage tubing Reconnect the client's tube to the drainage system Place the client in the high-Fowler position immediately
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Reconnect the client's tube to the drainage system
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A nurse is caring for a client who experienced a crushing chest injury. A chest tube is inserted. Which observation indicates a desired response to this treatment? Increased breath sounds Increased respiratory rate Crepitus detected on palpation of the chest Constant bubbling in the drainage collection chamber
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Increased breath sounds
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After thoracic surgery a client has a chest tube connected to a water-seal drainage system that is attached to suction. When excessive bubbling is observed in the water-seal chamber, the nurse should: Strip the chest tube catheter Check the system for air leaks Decrease the amount of suction pressure Recognize that the system is functioning correctly
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Check the system for air leaks
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A client has a closed chest drainage system in place. To determine the amount of chest tube drainage, the nurse should: Refer to the date and time markings on the outside of the collection chamber Aspirate the drainage from the collection chamber Replace the existing system with a new one to access the drainage in the existing system Clamp the chest tube and empty the fluid from the collection chamber
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Refer to the date and time markings on the outside of the collection chamber
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A client with a pneumothorax has a chest tube inserted and attached to a closed-chest drainage system. The client asks, "Why is the tube in my chest hooked up to a contraption with water in it?" The nurse explains that the water: Promotes pleural drainage via gravity Measures the pressures in the chest wall Prevents reflux of air back into the chest Ensures bubbling in the water-seal chamber
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Prevents reflux of air back into the chest
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A client is admitted to the hospital for a surgical resection of the lower left lobe of the lung. After surgery the client has a chest tube to a closed-chest drainage system. What should the nurse do to determine if the chest tube is patent? Milk the chest tube toward the drainage unit Check the amount of bubbling in the suction control chamber Observe for fluctuations of the fluid in the water-seal chamber Assess for extent of chest expansion in relation to breath sounds
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Observe for fluctuations of the fluid in the water-seal chamber
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A client who sustained chest trauma in an accident has bilateral chest tubes inserted. What is the nurse's primary responsibility when caring for this client? Maintaining a closed system Placing the client in the supine position Encouraging deep breathing and coughing Monitoring the client's oxygen saturation level
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Maintaining a closed system
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The nurse is caring for a client who had a wedge resection of a lobe of the lung and now has a chest tube with a three-chamber underwater drainage system in place. The nurse considers that the main purpose of the third chamber of the underwater drainage system is to: Act as a drainage container Provide an airtight water seal Control the amount of suction Allow for escape of air bubbles
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Control the amount of suction
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While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. What is the nurse's immediate action? Place the client in the supine position Spread a clamp in the insertion side to hold the site open Obtain a sterile Vaseline gauze to cover the opening Cover the opening with the cleanest material available
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Cover the opening with the cleanest material available
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A client is scheduled for coronary artery bypass surgery. The nurse explains to the client that chest tubes will be inserted during surgery to: Prevent atelectasis postoperatively Drain fluid from the pericardial sac Reestablish negative intrapleural pressure Monitor the amount of blood loss after surgery
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Reestablish negative intrapleural pressure
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A client sustains a stab wound to the chest, and a chest tube is inserted. Later the client's chest tube appears to be obstructed. What is the most appropriate nursing action? Instruct the client to cough. Clamp the tube immediately. Prepare for chest tube removal. Arrange for a stat chest x-ray film.
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Instruct the client to cough.
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A nurse is caring for a client with a pneumothorax who has a chest tube in place. What should the nurse do when caring for this client? Encourage range of motion to the client's arm on the affected side. Administer the prescribed cough suppressant at the prescribed times. Empty and measure the drainage in the collection chamber each shift. Apply clamps below the insertion site when getting the client out of bed.
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Encourage range of motion to the client's arm on the affected side.
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A nurse is caring for a client who has chest tubes inserted to treat a hemothorax that resulted from a crushing chest injury. A commonality of the various stationary chest tube drainage systems is that the first chamber is designed to: Collect drainage Ensure adequate suction Maintain negative pressure Sustain a continuance of the water seal
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Collect drainage
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A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. What is the primary purpose of the chest tube? Lessens the client's chest discomfort Restores negative pressure in the pleural space Drains accumulated fluid from the pleural cavity Prevents subcutaneous emphysema in the chest wall
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Restores negative pressure in the pleural space
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A nurse is caring for a client with a pneumothorax who has a chest tube in place with a closed drainage system. Which of these actions by the nurse is correct? Strip the chest tube periodically. Administer the prescribed cough suppressant at the scheduled times. Empty and measure the drainage in the collection chamber each shift. Keep the drainage system lower than the level of the client's chest
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Keep the drainage system lower than the level of the client's chest
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An infant who was in a motor vehicle collision has undergone open repair of a fractured sternum and now has a chest tube. What should the nurse explain to the infant's parents about the chest tube? "The tube doesn't cause discomfort. It's been put in place for emergency use." "The tube will be taken out once your baby is stable and oral feedings are started." "The tube has been placed to drain the air that entered the chest cavity during surgery." "The tube drains the air that accumulated in your baby's chest after the lung was punctured."
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"The tube has been placed to drain the air that entered the chest cavity during surgery."
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A client who had thoracic surgery is admitted to the postanesthesia care unit. What should the nurse do after the chest tube is attached to a disposable plastic waterseal drainage system? Ensure the security of the connections from the client to the drainage unit. Empty the drainage container and measure and record the amount once a day. Verify that there is vigorous bubbling in the wet suction control compartment. Check that the fluid level in the water seal compartment increases with expiration
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Ensure the security of the connections from the client to the drainage unit.
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A client with a chest tube is to be transported via a stretcher. When transporting the client, the nurse should keep the: Collection device attached to mechanical suction. Chest tube clamped distal to the water-seal chamber. Collection device below the level of the client's chest. Chest tube end covered with sterile gauze pads taped to the client
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Collection device below the level of the client's chest
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A nurse is caring for a client with a chest tube. How will complete lung expansion be determined before removal of the chest tube? Return of usual tidal volume Decreased adventitious sounds Absence of additional drainage Comparison of chest radiographs
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Comparison of chest radiographs
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Immediately after a thoracentesis, a client's right lung collapses. A chest tube is inserted and is attached to a three-chamber closed drainage system. What does the nurse assess about the fluid when the chest tube is functioning properly? Remains constant in the chest drainage chamber. Is bubbling gently in the chest drainage chamber. Is bubbling vigorously in the suction control chamber. Rises in the tube of the water seal chamber during inspiration
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Rises in the tube of the water seal chamber during inspiration
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How should the nurse monitor for the complication of subcutaneous emphysema after the insertion of chest tubes? Palpate around the tube insertion sites for crepitus. Auscultate the breath sounds for crackles and rhonchi. Observe the client for the presence of a barrel-shaped chest. Compare the length of inspiration with the length of expiration.
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Palpate around the tube insertion sites for crepitus.
