Thoracic Trauma

Second only to head and spinal injuries, thoracic injuries account for _______ of trauma deaths.

• 30%

• 20%

• 25%

• 35%

The anatomical structure located in the center of the thoracic cavity is the:

• Mediastinum

• Parietal pleura

• Visceral pleura

• Diaphragm

When is it beneficial to clamp a patient's chest tube?

• When ordered by a physician to simulate tube removal and assess the patient's response

• Whenever a patient leaves the nursing unit and cannot be monitored

• When ambulating a postoperative patient with a chest tube

• It is never beneficial to clamp a patient's chest tube.

New bubbling is observed in the water seal chamber after a patient with a pleural chest tube returns from a test. The nurse clamps the chest tube momentarily with a tubing clamp at the dressing site. When this is done, bubbling in the water seal stops, the next appropriate nursing action is to:

• Continue to monitor the water seal chamber for bubbling every hour for the next four hours.

• Do nothing. This bubbling is normal in patients with pleural chest tubes.

• Remove the chest tube dressing to see if one or more eyelets of the chest tube have been pulled out of the chest.

• Call the physician immediately and do not leave the patient's bedside because of the risk of respiratory failure.

Which of the following situations is likely to result in the absence of fluctuations in the chest drainage tubing?

• The tubing is coiled on the bed with a straight path to the chest drain.

• The tubing is blocked in some way.

• The patient is receiving positive pressure ventilation.

• The patient is ambulatory.

If the chest tube is pulled out of the patient's chest, and the patient had an air leak from the lung, after asking a colleague to call a physician STAT, emergency nursing management is to:

• Cover the opening with a sterile dressing taped on three sides

• Cover the opening with a sterile Vaseline gauze, taped securely on all sides

• Leave the opening alone and monitor the patient until a physician can assess the situation.

• Try to put the tube back in place as quickly as possible

A physician has just performed a thoracostomy for pleural effusion. The nurse handed the patient tubing from the drain to the physician, who attached it to the chest tube. The drain is properly filled with water and placed in an upright position below the patient's chest. The physician orders suction to the chest drain system. With a dry suction control chamber (as is present in the Atrium Oasis), how should the nurse adjust the vacuum source?

• Adjust the vacuum source until the dial on the vacuum regulator reads -20mmHg

• Adjust the vacuum source until constant, gentle bubbling just begins in the suction control chamber

• Adjust the vacuum source until the bellows indicator is all the way to the right of the indicator window

• Adjust the vacuum source until the bellows indicator reaches the arrow mark in the indicator window

In a self-contained, disposable chest drain, the amount of negative pressure transmitted to the patient by suction is determined by:

• The amount of suction set on the wall vacuum regulator

• The sensitivity of the high negative pressure relief valve

• The dial setting on the suction control chamber

• The level of water in the water seal chamber

In self-contained, disposable chest drains, the manual high negative pressure relief valve

• Allows water to be added to the system without disconnecting the patient tubing

• Alerts the nurse to a situation of high pressure within the system and automatically vents

• Allows filtered atmospheric air into the system to offset a rise in negative pressure

• Alerts the nurse to high suction levels accumulating in the system

A potentially life-threatening condition in which air and pressure rapidly accumulate in the pleural space and, if not treated, can result in a mediastinal shift is called:

• An open pneumothorax

• An iatrogenic pneumothorax

• A tension pneumothorax

• A spontaneous pneumothorax