Question

A patient with a chest tube has no fluctuation in the water seal chamber. What could be the cause of this?

Answer 1

Correct Answers:

the lung may have re-expanded or there is a kink in the system

Rationale :

🔷 Tidaling/fluctuation in the water seal chamber normally reflects pressure changes during breathing.

🔷 If fluctuation stops, it can mean the lung has re-expanded, which is an expected positive finding.

🔷 It can also mean there is a kink, dependent loop, clot, or obstruction preventing movement of air/fluid through the tubing.

🔷 The nurse should first assess the patient and inspect the tubing from the chest to the drainage system.

🔷 Absence of fluctuation is not automatically an emergency, but it requires assessment to confirm whether the cause is expected or obstructive.

There is an air leak in the tubing

🔷An air leak usually causes continuous bubbling in the water seal chamber.

🔷It does not typically cause absent fluctuation.

The suction needs adjusted

🔷Suction problems affect the suction-control chamber, not usually water seal fluctuation.

🔷 Adjusting suction is not the first explanation for absent tidaling.

The system is broken and needs to be replaced

🔷A broken system may cause leaking, loss of seal, or bubbling.

🔷 No fluctuation alone does not prove the system is broken.

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Answer 2

Correct Answers:

Replacing the dressing when it is damp, loose, or soiled

Rationale :

💎 Central line dressings must remain clean, dry, intact, and occlusive to reduce the risk of catheter-related bloodstream infection.

💎 A dressing that is damp, loose, or soiled no longer protects the insertion site properly.

💎 Moisture and loosened edges allow microorganisms to enter the catheter site more easily.

💎 The nurse should replace the dressing using sterile technique and agency policy.

💎 Routine central line care focuses on infection prevention, securement, and maintaining catheter patency.

Applying antimicrobial ointment to the catheter insertion site

💎Ointment is not routinely applied unless specifically prescribed or required by policy.

💎Ointments can trap moisture and may interfere with dressing adherence.

Cleansing the catheter insertion site with antiseptic each shift

💎The site is not cleansed every shift unless the dressing is being changed.

💎Frequent unnecessary manipulation increases contamination risk.

Changing the dressing every 24 hours

💎Transparent central line dressings are usually changed less frequently unless compromised.

💎A 24-hour change is unnecessary unless the dressing is damp, loose, or soiled.

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Answer 3

Correct Answers:

Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system

Rationale :

🎯 A cracked chest drainage system breaks the closed drainage seal, placing the patient at risk for air entering the pleural space.

🎯 The immediate priority is to re-establish a temporary water seal by placing the distal end of the chest tube tubing about 1 inch into sterile water.

🎯 This allows air to escape from the pleural space while preventing air from moving back into the chest.

🎯 After the temporary seal is created, the nurse should obtain and connect a new sterile drainage system.

🎯This action protects the patient from complications such as pneumothorax or tension pneumothorax.

Disconnect the drainage system and get a new one

🎯Disconnecting without creating a temporary water seal allows air to enter the pleural space.

🎯The nurse must protect the patient first before obtaining the new system.

Notify the HCP immediately

🎯The provider should be notified after immediate safety measures are taken.

🎯Restoring a temporary seal is the priority nursing action.

Place the patient in supine position and clamp the tubing

🎯Clamping can trap air in the pleural space and increase risk for tension pneumothorax.

🎯Supine positioning does not correct the broken drainage system.

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Answer 4

Correct Answers:

A PICC line in the patient's right upper arm

Rationale :

🔵 A PICC line is considered a central venous catheter because its tip terminates in a central vein, usually near the superior vena cava.

🔵 Although it is inserted through a peripheral vein in the upper arm, the catheter advances into the central circulation.

🔵 PICC lines are used for long-term IV therapy, irritating medications, parenteral nutrition, and frequent blood draws.

🔵 Central lines require strict infection-prevention measures because they provide direct access to central circulation.

🔵 The insertion location does not determine whether a line is central; the catheter tip location does.

A 16 gauge in the patient’s brachial vein

🔵This is a large-bore peripheral IV, not a central line.

🔵The catheter tip remains in a peripheral vein.

A midline IV in the patient’s left upper arm

🔵A midline is longer than a peripheral IV but does not reach central circulation.

🔵Its tip usually ends below the axilla.

An 18 gauge in the patient’s external jugular vein

🔵An external jugular peripheral IV is not automatically a central line.

🔵It is considered peripheral unless the catheter tip terminates centrally.

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Answer 5

Correct Answers:

Patients may walk around as long as the drain remains below the chest

Rationale :

🟢 A patient with a chest tube may ambulate if the drainage system remains intact and properly positioned.

🟢 The drainage system should stay below chest level to promote gravity drainage and prevent backflow into the pleural space.

🟢 The system should remain upright to maintain the water seal and accurate drainage measurement.

🟢 Tubing should be kept free from kinks and dependent loops during movement.

🟢 Ambulation can improve lung expansion, circulation, and postoperative recovery when performed safely.

If a patient is ambulatory, the chest tube should be clamped shut while the chest drain is disconnected from the patient

🟢Chest tubes should not be routinely clamped during ambulation.

🟢Clamping can trap air and increase risk for tension pneumothorax.

Patients may go only from bed to chair while the chest tube is connected to a chest drain

🟢Patients are not limited to bed-to-chair activity if stable.

🟢They may ambulate with proper drainage-system positioning.

If patient must leave nursing unit, suction tubing should be clamped shut while chest drain is disconnected from suction

🟢The suction tubing may be disconnected from wall suction if ordered, but the chest tube itself should remain connected to the drainage system.

🟢Clamping is not routine and can be dangerous.

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Answer 6

Correct Answers:

Keep the collection device upright at all times

Rationale :

🟣 The chest drainage collection device must remain upright to maintain correct chamber function.

🟣 Keeping it upright helps preserve the water seal and prevents fluid from spilling into the wrong chamber.

🟣 During ambulation, the device should also remain below the level of the chest to prevent backflow.

🟣 The nurse should teach the patient to avoid pulling, tipping, or lifting the drainage system above chest level.

🟣 Proper positioning supports safe drainage and helps prevent respiratory complications.

Allow the tubing to hang in a dependent loop when ambulating

🟣Dependent loops can collect fluid and obstruct drainage.

🟣Tubing should be straight and free from kinks.

Keep the collection device at chest level at all times

🟣The device should remain below chest level, not at chest level.

🟣This prevents drainage from flowing backward.

Disconnect the system when showering

🟣The chest drainage system should not be disconnected for showering.

🟣Disconnecting breaks the closed system and increases risk for air entry and infection.

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Answer 7

Correct Answers:

Consider the outer 1 inch of the sterile filed as contaminated

Rationale :

⭐ The outer 1 inch of a sterile field is considered contaminated because it is most likely to touch nonsterile surfaces.

⭐ During a central line dressing change, maintaining sterile technique is essential to prevent bloodstream infection.

⭐ The nurse should avoid placing sterile supplies or gloved hands near the edge of the sterile field.

⭐ Sterile items should be kept above waist level and within direct view.

⭐ A contaminated sterile field can introduce organisms directly into the central line insertion site.

Touch the insertion site with sterile gloves

⭐The insertion site should not be touched unless necessary and only after proper antiseptic preparation.

⭐Touching increases contamination risk.

Keep the bedside table below your waist

⭐A sterile field must remain above waist level.

⭐Anything below waist level is considered contaminated because it is outside the nurse’s view.

Readjust the patient’s mask

⭐Once sterile gloves are on, touching the patient’s mask would contaminate the gloves.

⭐The mask should be adjusted before donning sterile gloves.

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Answer 8

Correct Answers:

Check the drainage system for an air leak.

Rationale :

🔶 Continuous bubbling in the water seal chamber indicates an air leak somewhere in the system or from the patient.

🔶 The nurse should assess the drainage system and tubing connections to locate the source of the leak.

🔶 Intermittent bubbling may be expected with some pneumothorax cases, but continuous bubbling requires investigation.

🔶 The nurse should check for loose connections, cracks, or dislodgement while maintaining the closed system.

🔶 Identifying and correcting an air leak helps prevent ineffective drainage and respiratory compromise.

Increase the suction to the drainage system until the bubbling stops

🔶Increasing suction does not correct an air leak.

🔶It can worsen system disruption or cause unnecessary negative pressure.

Reposition the patient because the tubing is kinked

🔶A kink usually causes absent fluctuation or impaired drainage, not continuous bubbling.

🔶Repositioning alone does not address an air leak.

Continue to monitor the drainage system

🔶Continuous bubbling should not simply be observed without action.

🔶It requires assessment to determine the source of the leak.

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Answer 9

Correct Answers:

subcutaneous emphysema

Rationale :

🔴 Palpating around the chest tube insertion site helps assess for subcutaneous emphysema.

🔴 Subcutaneous emphysema occurs when air leaks into the tissue under the skin.

🔴 It feels like crackling, popping, or rice cereal under the fingers during palpation.

🔴 This finding can indicate an air leak or improper chest tube function.

🔴 The nurse should document the finding, monitor respiratory status, and notify the provider if it worsens.

Increasing drainage

🔴Drainage is assessed by observing the collection chamber, not by palpating the insertion site.

🔴Palpation does not measure chest tube output.

Lung re-expansion

🔴Lung re-expansion is assessed through respiratory status, breath sounds, chest x-ray, and improved oxygenation.

🔴Palpation around the insertion site does not confirm full re-expansion.

Chest-tube obstruction

🔴Obstruction is suspected with absent tidaling, decreased drainage, or respiratory distress.

🔴Palpation mainly checks for air trapped in tissue.

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Answer 10

Correct Answers:

"A surgical mask is used to prevent respiratory secretions contaminating the insertion site."

Rationale :

✅ During a central line dressing change, both nurse and patient may wear masks to prevent contamination from respiratory droplets.

✅ The central line insertion site provides direct access to the bloodstream, so infection prevention is critical.

✅ Talking, coughing, or breathing over the sterile field can introduce microorganisms.

✅ A surgical mask reduces the chance that oral or nasal secretions will contaminate the catheter site.

✅ This practice helps prevent central line-associated bloodstream infection.

“A surgical mask is used to prevent respiratory infections from chemical exposure.”

✅A surgical mask is not used primarily for chemical exposure protection.

✅Its purpose in this procedure is droplet and secretion control.

“A surgical mask should always be used for patients on contact precautions.”

✅Contact precautions focus on gown and gloves, not always a surgical mask.

✅A mask is used here because of central line sterile technique.

“A surgical mask is used to prevent coughing secretions on the nurse during the dressing change.”

✅Protecting the nurse is not the main reason for masking the patient during this sterile procedure.

✅The priority is preventing contamination of the insertion site.

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LPN NUR 113 CVAD/Chest Tube CRE

No.

1 :
A patient with a chest tube has no fluctuation in the water seal chamber. What could be the cause of this?

2 :
Proper, routine care of a central line includes which nursing action?

3 :
The patient in room 606 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?

4 :
Of the following, which line would be considered a central line?

5 :
Which of the following statements is true regarding patient movement while requiring chest drainage to water seal?

6 :
A nurse is planning education for a patient who has a chest tube in place attached to a closed-chest drainage system following surgery for lung cancer. Which of the following should the nurse emphasize to the patient when he is ready to ambulate freely?

7 :
The nurse has opened the sterile supplies and donned two sterile gloves to complete a central line dressing change. The nurse must:

8 :
You are providing care to a patient with a closed chest drainage system. On assessment of the drainage system, you note continuous bubbling in the water seal chamber. Which of the following is the correct nursing intervention for this type of finding?

9 :
A nurse is assessing a patient who has a chest tube in place attached to a closed-chest drainage system. When the nurse palpates the area around the chest- tube insertion site, she is checking for:

10 :
The nurse has applied a surgical mask on a patient receiving a central line dressing change. The nurse understands the rationale for including a mask on the patient during this procedure is:

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LPN NUR 113 CVAD/Chest Tube CRE

No.

1 : A patient with a chest tube has no fluctuation in the water seal chamber. What could be the cause of this?

2 : Proper, routine care of a central line includes which nursing action?

3 : The patient in room 606 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?

4 : Of the following, which line would be considered a central line?

5 : Which of the following statements is true regarding patient movement while requiring chest drainage to water seal?

6 : A nurse is planning education for a patient who has a chest tube in place attached to a closed-chest drainage system following surgery for lung cancer. Which of the following should the nurse emphasize to the patient when he is ready to ambulate freely?

7 : The nurse has opened the sterile supplies and donned two sterile gloves to complete a central line dressing change. The nurse must:

8 : You are providing care to a patient with a closed chest drainage system. On assessment of the drainage system, you note continuous bubbling in the water seal chamber. Which of the following is the correct nursing intervention for this type of finding?

9 : A nurse is assessing a patient who has a chest tube in place attached to a closed-chest drainage system. When the nurse palpates the area around the chest- tube insertion site, she is checking for:

10 : The nurse has applied a surgical mask on a patient receiving a central line dressing change. The nurse understands the rationale for including a mask on the patient during this procedure is:

1 :
A patient with a chest tube has no fluctuation in the water seal chamber. What could be the cause of this?

2 :
Proper, routine care of a central line includes which nursing action?

3 :
The patient in room 606 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?

4 :
Of the following, which line would be considered a central line?

5 :
Which of the following statements is true regarding patient movement while requiring chest drainage to water seal?

6 :
A nurse is planning education for a patient who has a chest tube in place attached to a closed-chest drainage system following surgery for lung cancer. Which of the following should the nurse emphasize to the patient when he is ready to ambulate freely?

7 :
The nurse has opened the sterile supplies and donned two sterile gloves to complete a central line dressing change. The nurse must:

8 :
You are providing care to a patient with a closed chest drainage system. On assessment of the drainage system, you note continuous bubbling in the water seal chamber. Which of the following is the correct nursing intervention for this type of finding?

9 :
A nurse is assessing a patient who has a chest tube in place attached to a closed-chest drainage system. When the nurse palpates the area around the chest- tube insertion site, she is checking for:

10 :
The nurse has applied a surgical mask on a patient receiving a central line dressing change. The nurse understands the rationale for including a mask on the patient during this procedure is: