Chest Tubes post 5Q 5/19/25

Front

A nurse is caring for a client with a newly placed chest tube for a pneumothorax. The nurse observes continuous bubbling in the water seal chamber. What is the priority nursing intervention?

Back

Check the system for leaks and loose connections.

Answer explanation

Rationale:  
Continuous bubbling in the water seal chamber suggests an air leak in the chest tube system. The nurse should assess connections and dressing integrity, ensuring the tubing is secure before escalating concerns. Clamping the chest tube may worsen tension pneumothorax. 

Front

A nurse is assessing a client with a chest tube who has developed subcutaneous emphysema. Which finding requires urgent intervention? Mild localized swelling around the chest tube insertion site, Crackling upon palpation under the skin extending toward the neck, Slight tenderness at the chest tube site without respiratory distress, An initial air leak in the drainage system right after insertion

Back

Crackling upon palpation under the skin extending toward the neck

Answer explanation

Rationale: Crackling under the skin extending toward the neck suggests worsening subcutaneous emphysema, which may progress to airway compromise, requiring immediate intervention. Mild swelling and slight tenderness are expected findings and do not indicate an urgent issue. A small, stable air leak in the chest tube drainage system can occur but is not necessarily an emergency unless it worsens significantly. 

Front

A nurse is assessing a client with a chest tube and notices no fluctuation (tidaling) in the water seal chamber. Obstruction in the chest tube drainage has been ruled out as a cause. What is the most likely cause in this situation?

Back

The lung has fully re-expanded

Answer explanation

Rationale: Obstruction in the chest tube drainage is the most common cause of no fluctuation or tidaling. However, once that has been ruled out as a cause, once the lung has fully re-expanded, no further fluctuation (tidal breathing) occurs in the water seal chamber because intrapleural pressure changes have stabilized.   

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