Chest tube practice questions for the NCLEX exam. Chest tubes are used in the clinical setting to help drain fluid or air from the pleural space of the lungs or after cardiac surgery to help prevent fluid from compressing the heart (which are mediastinal chest tubes).
The nurse is responsible for monitoring and maintaining the chest tube drainage system. This includes recording drainage, monitoring for air leaks or kinks, assessing suction settings, monitoring patient’s respiratory status, and assisting the physician with removal of the chest tube.
After you’re done taking this quiz, don’t forget to take our other free NCLEX quizzes.
Lecture on Chest Tube Care
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NCLEX Questions on Chest Tube Care
1. You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding?
A. Reposition the patient because the tubing is kinked.
B. Continue to monitor the drainage system.
C. Increase the suction to the drainage system until the bubbling stops.
D. Check the drainage system for an air leak.
2. A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find?
A. The water in the chamber will increase during inspiration and decrease during expiration.
B. There will be continuous bubbling noted in the chamber.
C. The water in the chamber will decrease during inspiration and increase during expiration.
D. The water in the chamber will not move.
3. What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.
A. Mediastinal chest tube system
B. Dry suction chest tube system
C. Wet suction chest tube system
D. Dry-Wet suction chest tube system
4. The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
5. You’re assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?
A. Document your findings as normal.
B. Assess for an air leak due to bubbling noted in the suction chamber.
C. Notify the physician about the drainage.
D. Milk the tubing to ensure patency of the tubes.
6. A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?
A. Intermittent bubbling may be noted in the water seal chamber.
B. 200 cc of drainage per hour is expected during recovery of a pneumothorax.
C. The chest tube is positioned at the patient’s chest level to facilitate drainage.
D. All of these options are appropriate findings.
7. While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention?
A. Stay with the patient and monitor their vital signs while another nurse notifies the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
C. Attempt to re-insert the tube.
D. Keep the site open to air and notify the physician.
8. A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply:
A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed.
B. Gather supplies needed which will include petroleum gauze dressing per physician preference.
C. Place the patient in Semi-Fowler’s position.
D. Have the patient take a deep breath, exhale, and bear down during removal of the tube.
E. Pre-medicate prior to removal as ordered by the physician.
F. Place the patient is prone position after removal.
9. A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?
A. This is an expected finding.
B. The lung may have re-expanded or there is a kink in the system.
C. The system is broken and needs to be replaced.
D. There is an air leak in the tubing.
Answer Key
1. D 2. C 3. B 4. D 5. A 6. A 7. B 8. B, C, D, E 9. B
More NCLEX Quizzes: Caring for Patients with Tubes
A chest tube can help drain air, blood, or fluid from the pleural space, which is the space surrounding your lungs.
Inserting a chest tube is called a chest tube thoracostomy. It’s typically an emergency procedure, but it might also be done if you’ve had surgery done on the organs or tissues in your chest cavity.
During chest tube insertion, a hollow plastic tube is inserted between your ribs into the pleural space. This tube may be connected to a machine to help with the drainage. The tube will stay in place until the fluid, blood, or air is drained from your chest.
You may need a chest tube insertion if you have any of the following:
- a collapsed lung
- a lung infection like bacterial pneumonia complicated by collection of pus
- pneumothorax, which is air around or outside the lung
- bleeding around your lung, especially after a trauma (like a car accident)
- fluid buildup due to another medical condition, like cancer or pneumonia
- breathing difficulty due to a buildup of fluid or air
- surgery, especially lung, heart, or esophageal surgery
Your doctor might also insert a chest tube if they need to diagnose certain conditions, like lung damage or internal injuries.
Since chest tube insertion is most commonly performed as an emergency procedure or after surgery, there’s usually no way for you to prepare for it.
If you’re conscious and your doctor thinks it’s necessary to insert a chest tube, they’ll ask for your consent. If you’re unconscious, they’ll explain why the chest tube was necessary after you wake up.
In cases where a chest tube insertion isn’t an emergency, your doctor will first order a chest X-ray so they can confirm whether you have a buildup of fluid or air causing your symptoms. Your doctor might also order some other tests to evaluate the pleural fluid, like a chest ultrasound or chest CT scan.
Usually, a chest tube procedure is performed by a surgeon or a pulmonary specialist, which is someone who specializes in lung conditions and diseases.
These are the steps involved in the procedure:
Preparation
Your doctor will start by preparing a large area on the side of your chest, from your armpit down to your abdomen and across to your nipple. This will involve sterilizing the area and shaving any hair near the insertion site, if necessary.
Your doctor may also sometimes use an ultrasound to identify a good location for inserting the tube.
Anesthesia
Your doctor may inject an anesthetic into your skin or vein to numb the area where they’ll be inserting the chest tube. This anesthetic medication will help make you more comfortable during the procedure because it can otherwise be painful.
If you’re having major heart or lung surgery, you’ll likely be given general anesthesia and be put to sleep before the chest tube is inserted.
Incision
Using a scalpel, your doctor will make a small (1/4- to 1 1/2-inch) incision between your ribs, near the upper part of your chest. The exact place they make this incision will depend on why you need a chest tube.
Insertion
Your doctor will then gently open a space into your chest cavity and guide the tube into your chest. Chest tubes come in various sizes for different conditions.
Your doctor will stitch the chest tube in place to prevent it from moving during the procedure. A sterile bandage will be applied over the insertion site.
Drainage
The tube is then attached to a special one-way drainage system that allows air or fluid to flow out only. This prevents the fluid or air from flowing back into the chest cavity.
While the chest tube is in, you’ll probably need to stay in the hospital. A doctor or nurse will monitor your breathing and check for possible air leaks.
How long the chest tube is left in depends on the condition that caused the buildup of air or fluid. Some lung cancers can cause fluid to accumulate, so your doctor may leave the tube in for a longer period of time in these cases.
Before a chest tube is inserted into the chest, the other end of the tube is put into a drainage system. This system consists of a bottle to collect the air or fluid and a leakage barrier water seal.
The leakage barrier water seal is created when the bottle is filled with a saline solution. Then one end of the tube is inserted into 2 cm of that saline solution, and the other is inserted into the pleural cavity.
This decompresses the pressure from the chest — or creates negative pressure — and removes the liquid or air because the pressure around the lungs is lower than the atmospheric pressure outside the body.
Chest tube insertion puts you at risk of several complications. These include:
- Pain during placement. Chest tube insertion is usually very painful. Your doctor will help manage your pain by injecting an anesthetic through an IV or directly into the chest tube site. You’ll be given either general anesthesia, which puts you to sleep, or local anesthesia, which numbs the area.
- Infection. As with any invasive procedure, there’s a risk of infection. The use of sterile tools during the procedure helps reduce this risk.
- Bleeding. A very small amount of bleeding can occur if a blood vessel is damaged when the chest tube is inserted.
- Poor tube placement. In some cases, the chest tube can be placed too far inside or not far enough inside the pleural space. The tube may fall out in this case. This is why you’ll be kept in the hospital to monitor.
Serious complications
Serious complications are rare, but they can include:
- bleeding into the pleural space
- injury to the lung, diaphragm, or stomach
- collapsed lung during tube removal
Chest tube infection symptoms
One of the complications that can arise from a chest tube placement is an infection, or empyema. This occurs when bacteria enter the body around the tube and causes a lung infection.
The risk of infection increases the longer the chest tube is in your body, though your doctor can reduce your risk of infection if they bandage the skin around the tube insertion.
Signs of a lung infection from a chest tube insertion include:
The chest tube usually stays in for a few days. After your doctor is sure that no more fluid or air needs to be drained, the chest tube will be removed.
The removal of the chest tube is usually performed quickly and without sedation. Your doctor will give you specific instructions on how to breathe when the tube is removed. In most cases, the chest tube will be removed as you’re holding your breath. This ensures extra air doesn’t get into your lungs.
After the doctor removes the chest tube, they’ll apply a bandage over the insertion site. You may have a small scar. Your doctor will likely schedule an X-ray at a later date to make sure that there isn’t another buildup of air or fluid inside your chest.
Sometimes, your doctor might prescribe antibiotics to prevent or treat an infection.
You won’t be discharged from the hospital until your incision site starts to heal. Before you leave, it can be helpful to ask your nurses to see what the incision looks like so you know how big it is and can notice any signs that it isn’t healing properly.
Don’t panic if there’s some light yellow or pink-colored drainage from the incision site — this can happen. If it does though, do write down the amount and color, and check if it smells. If it does smell, call your doctor and let them know.
If the drainage changes quickly or becomes substantial, you should also give your doctor a call.
You should keep your incision covered for at least 48 hours after the chest tube is removed, but you should wear it longer if you’re noticing discharge. If the bandage gets wet for any reason, change it quickly with a new dry one.
During your recovery, make sure to take care of yourself by:
- getting some light exercise, even if it’s just a short walk outside, but see if you can do a little more each day
- use your incentive spirometer, a device they’ll send home with you
- do deep breathing and cough often to help re-expand your lungs
- eat balanced meals regularly
- drink lots of water
- avoid alcohol and smoking, as both can interfere with your recovery
- avoid anyone that’s sick in your household, as bacteria could cause you to get an infection
- get plenty of rest at night, but try avoiding naps during the day
- keep household activities light
- take your any prescribed medication on a schedule
- shower before sleeping
It usually takes about 3-4 weeks to recover from having a chest tube. Don’t drive until you’re able to fully use your arm and shoulder.
You’ll have a small scar from the procedure.
Chest tubes can be effective at draining fluid and air from the pleural space. In many cases, it can help eliminate the need for a more invasive surgery.
Sometimes, though, it does not drain the space enough, and you may need surgery. Some people also develop a collapsed lung after removal of the tube, as well as bleeding in the pleural space, which might require more intensive treatment.
Are chest tubes painful?
When the procedure is performed, your doctor will likely use an anesthetic to numb your pain. But both the procedure and recovery can be painful.
One study found that 50 percent of patients experienced a pain level of 9 or 10 on a scale of 10.
You’ll be prescribed pain medications after the procedure to manage your pain post-procedure.
Can a chest tube cause nerve damage?
Yes, an incorrectly inserted chest tube can damage organs in your chest or m. Specifically, is can cause intercostal nerve impairment. This is one of the possible complications of this procedure.
Can a chest tube cause pneumonia?
Chest tubes can be used to remove pus from a pneumonia infection, and some patients may need re-intervention after the tube is removed because it doesn’t remove all the fluid.
But the tube itself doesn’t cause pneumonia.
Should my chest tube bubble?
It’s normal for there to be some intermittent air bubbling through the water seal chamber once your chest tube is inserted. This usually occurs when you cough or exhale.
But continuous air bubbling isn’t usual and could mean there is a leak in the tube.
A chest tube thoracostomy — or chest tube insertion — is an emergency, life-saving procedure that can be done when there’s air or fluid in your chest cavity, affecting your ability to breathe. It can also be performed if you have a collapsed lung.
This procedure, which involves putting a chest tube into your pleural space to remove the air or fluid, can lessen the chances that you’d need invasive surgery, but it’s not without risks. It’s possible to develop infections or have a buildup of fluid after the tube is removed.
Recovery from a chest tube insertion generally takes 3-4 weeks, but you can make a full recovery with just a small scar.