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?

Accepted Answer

The patient will present with dyspnea,a fall in oxygen saturation,and hyperresonance to percussion if the problem is air or a pneumothorax.

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?

Accepted Answer

Providone-iodine solution should be placed into a sterile cup molded into the tray.The physician will apply the antiseptic to the site of the chest tube insertion to minimize the risk of infection.Following application of antiseptic,he or she may use disposable sterile drapes to form a sterile field.

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?

Accepted Answer

If the leak persists when the tubing is clamped at the patient's chest tube,the leak is in the drainage system.Move the clamp in short intervals,briefly clamping each time,while moving closer to the collection chamber.If the bubbling stops,the leak is in the connecting tubing (between the chest tube and the collection chamber).The tubing has a hole and must be replaced.If you reach the collection chamber itself and clamp the tubing where it enters the chamber and the leak stops,the leak is in the drainage system and the whole unit must be replaced.

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?

Accepted Answer

The physician may order an analgesic,such as midazolam,prior to the procedure to help relax the patient.

Question 5

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

Accepted Answer

Leaks are identified by observing continuous bubbling in the water seal chamber.Normally,the water seal chamber will occasionally bubble as air is evacuated from the pleural or mediastinal space.If continuous bubbling occurs,there is an air leak either within the thorax or externally in the tubing and connections.

Question 6

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

Accepted Answer

If too little water is in the chamber (less than 2 cm),there is increased risk that with a deep breath (increased subambient pressure in the thorax),air could be drawn into the thoracic cavity.

Question 7

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

Accepted Answer

The collection chamber is the part of the drainage system that collects fluids from the patient.It is calibrated in milliliters (ml)and is commonly subdivided into columns of 600 to 1000 ml per column.By observing the collection chamber,you can assess the amount of drainage and its color and consistency over time.

Question 8

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

Accepted Answer

The level of vacuum that is applied is directly proportional to the depth of water in the suction control chamber.

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?

Accepted Answer

Proper water level (2 cm H₂O)is very important in the water seal chamber.

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?

Accepted Answer

A drain is placed posteriorly along the base of the lung to remove fluid as it is collected.Gravity will cause the fluid to collect in the lowest part of the thorax,owing to its greater density.

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?

Accepted Answer

Draw up 4% lidocaine into a syringe in preparation for the procedure.The physician will use local anesthetic at the point of insertion.

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

Accepted Answer

Chest tubes are indicated to remove I)pus,II)air,III)blood,or IV)pleural fluid from the thoracic cavity.Chest drains may be placed in the mediastinal space or the pleural space.

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?

Accepted Answer

Air will migrate preferentially to the least gravity-dependent (highest)area owing to its decreased density.Therefore,chest tubes are placed anteriorly near the apex of the lung to remove the free pleural air.

Question 14

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

Accepted Answer

Once chest tube is sutured in place,a)a sterile petrolatum gauze dressing may be applied around the chest tube and b)a sterile airtight dressing is then applied over the gauze dressing to prevent dissection of air into the pleural space around the tube through the incision site.

Question 15

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

Accepted Answer

A trocar is a rigid metal rod that is inserted into the chest tube for insertion.The trocar provides stiffness to the otherwise flexible polyvinyl chloride (PVC)tubes,allowing it to be advanced into place by separating tissue.Once the tube is properly positioned,the trocar is removed,leaving the hollow chest tube to perform its function.

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?

Accepted Answer

Air will migrate preferentially to the least gravity-dependent (highest)area owing to its decreased density.Therefore,the chest radiograph should be assessed in the apex of the lung to detect a small pneumothorax.A exhalation chest radiograph is sometimes taken to detect a small pneumothorax at the apex of the lung.

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?

Accepted Answer

If the patient is not in distress and appears out of any danger,assess the system for leaks.First,check all tubing connections.Connections should be tight and taped with pink surgical tape (airtight and watertight)to prevent leaks.If the leak persists,using a toothless clamp (one that won't puncture the surgical tubing),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.

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?

Accepted Answer

The water seal chamber 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.The water seal chamber is the center portion of the collection system.

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 _________________

Accepted Answer

Air or fluid in the pleural space will cause a loss of lung volume on the affected side.

Question 20

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

Accepted Answer

The suction control chamber regulates the amount of vacuum applied to the chest tube and thus to the patient's thoracic cavity to drain the fluid from the empyema from the patient's chest.The suction control chamber is the chamber most distal from the patient's chest tube.

Quiz 22: Chest Tubes