Deck 22: Chest Tubes

Question 1

A patient is admitted to the emergency department after a motor vehicle accident.A chest radiograph reveals a pneumothorax on the left side.What percussion note could the respiratory care practitioner expect to hear over the right chest?

A) Resonant
B) Flat
C) Hyperresonant
D) Dull

Answer 1

Hyperresonant

Question 2

Which of the following would you suggest to the physician to minimize the risk of infection during the insertion of a chest tube?

A) 4% Lidocaine
B) Midazolam
C) Providone-iodine
D) Aspirin

Answer 2

Providone-iodine

Question 3

While troubleshooting a chest tube leak,the respiratory care practitioner clamps the tubing where it enters the chamber and the leak stops.Where is the leak in the system?

A) In the tubing
B) In the patient's chest
C) At the vacuum regulator
D) In the drainage system

Answer 3

In the drainage system

Question 4

Which of the following drugs would you suggest to the physician as an analgesic to help relax the patient before the insertion of a chest tube?

A) 4% Lidocaine
B) Midazolam
C) Providone-iodine
D) Aspirin

Question 5

If the respiratory care practitioner observes continuous bubbling in the water seal chamber,what is the problem causing this phenomenon?

A) Air leak within the thorax
B) Air leak on the chest tube
C) Air leak at the tubing connections
D) Any of these

Question 6

If too little water is in the water seal chamber,which of the following could happen to the patient?

A) Air could be inhibited from leaving the thoracic cavity
B) Less vacuum could be applied to the thoracic cavity
C) Air could be drawn into the thoracic cavity
D) Too much fluid or air could be evacuated from the thoracic cavity

Question 7

Which part/chamber of the chest tube would collect blood from a patient who has suffered chest trauma?

A) Collection chamber
B) Water seal chamber
C) Chest tube tubing
D) Suction control chamber

Question 8

What controls the amount of suction applied to a patient's chest tube?

A) The vacuum regulator on the wall outlet
B) The depth of water in the suction control chamber
C) The direction the chest tube is positioned in the patient's chest
D) The diameter of the patient's chest tube

Question 9

When preparing a chest tube drainage system for use on a patient,what should the respiratory care practitioner do to the water seal chamber of the drainage system?

A) Fill the chamber with water to the 20 cm H2O line
B) Fill the chamber with water to the 2 cm H2O line
C) Attach the tubing that goes to the chest tube to the water seal chamber
D) Adjust the suction pressure at the wall outlet to full vacuum

Question 10

A chest radiograph reveals a massive pleural effusion in the patient's left thorax.How should the chest tube be positioned to drain the effusion?

A) Anteriorly near the apex of the lung
B) Posteriorly along the base of the lung
C) Medially toward the mediastinum
D) Laterally toward the periphery of the lung

Question 11

Which of the following drugs would you suggest to the physician as a local anesthetic to use at the point of insertion of a chest tube?

A) 4% Lidocaine
B) Midazolam
C) Providone-iodine
D) Aspirin cream

Question 12

Chest tubes are indicated to remove which of the following from a patient's thoracic cavity?
I.Pus
II.Air
III.Blood
IV.Fluid

A) I and II
B) III and IV
C) II only
D) I, II, III, IV

Question 13

A chest radiograph reveals a large pneumothorax in the patient's left chest.How should the chest tube be positioned to drain the pneumothorax?

A) Medially toward the mediastinum
B) Laterally toward the periphery of the lung
C) Anteriorly near the apex of the lung
D) Posteriorly along the base of the lung

Question 14

Once the chest tube has been sutured in place,the practitioner should help the physician by doing what to the dressing site?

A) Applying a sterile petrolatum dressing around the chest tube site
B) Applying a sterile airtight dressing at the chest tube site
C) Applying providone-iodine to the insertion site
D) a and b

Question 15

What is the name of the rigid metal rod that is inserted into the chest tube for insertion?

A) Trocar
B) Chest drain
C) Chest tube
D) Polyvinyl chloride tube

Question 16

A patient is admitted to the emergency department after being involved in a motor vehicle accident.The patient has massive chest trauma and the physician is suspicious that he has a pneumothorax,though the patient has bilateral chest movement.Where on the chest radiograph would you look to find a smaller pneumothorax?

A) Base of the lung
B) Lateral periphery of the lung
C) Apex of the lung
D) Mediastinum

Question 17

Continuous bubbling is noted in the water seal chamber.How should the respiratory care practitioner determine if the leak is in the tubing or the patient's chest?

A) Briefly clamp the tubing where it attaches to the patient's chest tube. If the bubbling stops, the leak is in the patient's chest.
B) Briefly clamp the tubing where it attaches to the patient's chest tube. If the bubbling continues, the leak is in the patient's chest.
C) Move a clamp in short intervals, briefly clamping the chest tube each time, while moving closer to the collection chamber. If the bubbling stops, the leak is in the patient's chest.
D) Observe the patient breathing and visually and observe the continuous bubbling. If the continuous bubbling occurs during inspiration, the leak is in the patient's chest.

Question 18

Which part/chamber of the chest tube acts as a one-way valve,allowing air to escape from the pleural or mediastinal space but not allowing it to enter those spaces from the atmosphere?

A) Collection chamber
B) Water seal chamber
C) Chest tube tubing
D) Suction control chamber

Question 19

A postoperative patient who has just had thoracic surgery has just been admitted to the Surgical Intensive Care Unit with a chest tube in his right side.It becomes obstructed with blood.This will cause loss of lung volume _________________

A) on the unaffected side.
B) on the affected side.
C) only if the patient coughs.
D) if there is a cardiac tamponade.

Question 20

Which part/chamber of the chest tube regulates the vacuum to the patient's chest to drain an empyema?

A) Collection chamber
B) Water seal chamber
C) Chest tube tubing
D) Suction control chamber

Question 21

What does continuous bubbling in the water seal chamber indicate?

A) A leak in the chest tube system
B) Active fluid drainage from the patient's chest
C) Active air drainage from the patient's chest
D) The chest tube is correctly positioned in the patient's chest

Question 22

What is "tidaling"?

A) Gentle continuous bubbling observed in the suction control chamber
B) Vigorous bubbling observed in the suction control chamber
C) Fluid collection in the collection chamber
D) The normal rise and fall of the fluid level with the patient's breathing pattern

Question 23

What should be done to the connections of the chest tube to prevent leaks?

A) Apply a water soluble jelly to the connections
B) Tape the connections with a watertight /airtight tape
C) Cut the ends of the connections to make them wider
D) Dry the connections with sterile gauze

Question 24

A patient with a chest tube in place suddenly develops chest pain and severe respiratory distress.What could be causing this?

Question 25

Once the chest tube has been inserted,a large loop is inadvertently left in the chest tube tubing.What can happen because of the loop in the tubing?

A) Air evacuation can be enhanced by this
B) It can cause a leak in the system
C) It can collect fluid, stopping fluid flow from the chest
D) Nothing a large loop should always be made in a chest tube tubing

Question 26

A pneumothorax develops while a patient is being mechanically ventilated.A chest tube is placed and the lung fails to seal.There is a large amount of air bubbling through the water seal chamber.What could be causing this?

Question 27

How should the vacuum regulator be adjusted after the set-up of a chest tube system?

A) Adjust until gentle continuous bubbling is observed in the suction control chamber
B) Adjust until vigorous continuous bubbling is observed in the suction control chamber
C) Adjust the vacuum regulator to full vacuum
D) The chest tube should not be connected to wall vacuum

Question 28

A patient with a chest tube in place develops swelling of the tissue surrounding the chest tube with crackling sensations also noted in the same area.What could be causing this and how is it treated?

Question 29

If the water level in the water seal chamber is too low,what can be the hazard to the patient?

A) More vacuum is applied to the patient's thoracic cavity
B) Increases the risk of entry of atmospheric air into the patient's thoracic cavity
C) It makes it more difficult for air or fluid to drain
D) A leak can occur in the drainage system

Question 30

If the chest tube drainage system needs to be changed,when should it be done?

A) During inhalation
B) During expiration
C) During spontaneous breathing
D) During positive-pressure ventilation

Question 31

After insertion of a chest tube,how should the position of the chest tube be assessed?

A) By auscultating the patient's chest
B) By percussing the patient's thoracic cavity
C) By having the patient cough and observing the drainage chamber bottle
D) By obtaining a chest radiograph