Chest Tube practice exam NCLEX

A client with a chest tube to water seal drainage suddenly becomes short of breath and cyanotic. The nurse notices the chest tube is clamped. What is the nurse’s first action?

• A. Apply oxygen via non-rebreather mask

• B. Unclamp the chest tube immediately

• C. Call the rapid response team

• D. Auscultate lung sounds

✅ B. Unclamp the chest tube immediately

The nurse is caring for a client with a chest tube for pleural effusion. Which findings should be reported to the healthcare provider?

• A. Sudden increase in drainage to 200 mL in 1 hour

• B. Cloudy or foul-smelling drainage

• C. Drainage of 80 mL over 4 hours

• D. New onset of subcutaneous emphysema

• E. Clear serous drainage 24 hours post-insertion

• ✅ A. Sudden increase in drainage to 200 mL in 1 hour

• ✅ B. Cloudy or foul-smelling drainage

• ✅ D. New onset of subcutaneous emphysema

The nurse is setting up a new chest drainage system. The chamber that maintains negative pressure using gentle suction is the (select)
→ (Drop-down: suction control chamber, water seal chamber, collection chamber, air leak monitor)

✅ suction control chamber

The nurse is providing discharge instructions for a client going home with a chest tube and Heimlich valve. Which statements indicate a need for further teaching?

• A. “I will clamp the tube before showering.”

• B. “I will watch for redness or swelling at the site.”

• C. “If the valve falls off, I’ll reconnect it when I get a chance.”

• D. “I’ll avoid lifting heavy objects or doing vigorous activity.”

• E. “I should ignore small amounts of bubbling or hissing sounds.”

• ✅ A. “I will clamp the tube before showering.”

• ✅ C. “If the valve falls off, I’ll reconnect it when I get a chance.”

• ✅ E. “I should ignore small amounts of bubbling or hissing sounds.”

Which of the following findings indicates a possible complication of chest tube therapy?

• A. Serosanguinous drainage of 100 mL/day

• B. Continuous bubbling in the water seal chamber

• C. Fluctuation in the water seal chamber with breathing

• D. Drainage output of 50 mL/hr immediately post-insertion

✅ B. Continuous bubbling in the water seal chamber

Match the complication with the expected assessment finding.

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Complication	Finding
Tension pneumothorax	[ ] Tracheal deviation, hypotension
Dislodged chest tube	[ ] Sucking sound at insertion site
Hemothorax	[ ] Sudden increase in bloody drainage
Obstructed tube	[ ] No fluctuation in water seal chamber

• Tension pneumothorax → Tracheal deviation, hypotension

• Dislodged chest tube → Sucking sound at insertion site

• Hemothorax → Sudden increase in bloody drainage

• Obstructed tube → No fluctuation in water seal chamber

Review the documentation. Click to highlight the part that indicates a concern requiring intervention.

“Chest tube in place on right side. Drainage collection system connected and placed below chest level. Dressing changed with clean gloves. 80 mL serosanguinous drainage in 4 hours. Client denies pain.”

✅ Highlight: “Dressing changed with clean gloves”

Which of the following is an appropriate intervention when assisting with chest tube removal?

• A. Have the client take a deep breath and cough

• B. Instruct the client to perform the Valsalva maneuver

• C. Clamp the chest tube before removal

• D. Remove the chest tube during client inspiration

✅ B. Instruct the client to perform the Valsalva maneuver

The nurse is assessing a client’s chest drainage system. Which of the following are expected findings?

• A. Gentle bubbling in the suction control chamber

• B. Tidaling in the water seal chamber

• C. Continuous bubbling in the water seal chamber

• D. The drainage system placed at chest level

• E. Secure tubing connections with no dependent loops

• ✅ A. Gentle bubbling in the suction control chamber

• ✅ B. Tidaling in the water seal chamber

• ✅ E. Secure tubing connections with no dependent loops

The nurse enters the room and finds the chest tube has completely dislodged from the client. The nurse should immediately (select)
→ (Drop-down: apply sterile occlusive dressing, reconnect the tube, flush the tube, clamp the insertion site)

✅ apply sterile occlusive dressing

A client’s chest tube drainage suddenly stops, and the nurse notes absent tidaling in the water seal chamber. What is the nurse’s next best action?

• A. Clamp the tube and notify the provider

• B. Assess the tubing for kinks or clots

• C. Replace the drainage system

• D. Document and continue monitoring

✅ B. Assess the tubing for kinks or clots

Place the nursing actions in the correct order after a chest tube is inserted.

• Monitor respiratory status

• Tape all connections securely

• Assess chest tube drainage and fluctuation

• Position the drainage system below chest level

• Apply sterile dressing to insertion site

1. Apply sterile dressing to insertion site

2. Tape all connections securely

3. Position the drainage system below chest level

4. Assess chest tube drainage and fluctuation

5. Monitor respiratory status

Which actions are correct when setting up a chest drainage system?

• A. Fill the water seal chamber to 2 cm with sterile water

• B. Connect the suction tubing to wall suction

• C. Use distilled water in the suction control chamber

• D. Clamp the chest tube before connecting to the system

• E. Ensure the system is below the level of the chest

• ✅ A. Fill the water seal chamber to 2 cm with sterile water

• ✅ B. Connect the suction tubing to wall suction

• ✅ E. Ensure the system is below the level of the chest

A nurse notices constant bubbling in the water seal chamber. What is the most appropriate nursing action?

• A. Increase wall suction

• B. Assess the chest tube system for an air leak

• C. Document as a normal finding

• D. Clamp the chest tube for 30 minutes

✅ B. Assess the chest tube system for an air leak

Match the intervention with the rationale.

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Intervention	Rationale
Keep drainage system below chest level	[ ] Promotes gravity drainage
Monitor for subcutaneous emphysema	[ ] Detects potential air leakage
Encourage use of incentive spirometer	[ ] Prevents atelectasis
Tape all tube connections securely	[ ] Prevents accidental disconnection

• Keep drainage system below chest level → Promotes gravity drainage

• Monitor for subcutaneous emphysema → Detects potential air leakage

• Encourage use of incentive spirometer → Prevents atelectasis

• Tape all tube connections securely → Prevents accidental disconnection