Practice Question
A nurse is assessing a client who has a chest tube following a thoracotomy. Which of the following findings requires intervention by the nurse?
Answer Choices:
Correct Answer:
1 cm of water present in the water seal chamber
Rationale:
🔵 The water seal chamber of a chest drainage system must contain exactly 2 cm of sterile water to create a proper one-way valve that prevents air from re-entering the pleural space.
🔵 Only 1 cm of water indicates inadequate sealing, which could allow air to flow back into the chest cavity, leading to pneumothorax recurrence or compromised lung expansion.
🔵 Nurses must routinely assess and maintain the correct water level in the chamber; if it's low, sterile water should be added immediately under sterile technique.
🔵 All other findings are expected and normal:
— Tidaling reflects pressure changes with breathing.
— -20 cm H₂O suction is standard for adult chest drainage.
— A partially full drainage collection chamber is normal unless there’s sudden increase in volume or presence of bright red blood.
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This question is from VATI ATI Predictor 2023 which contains 174 questions.
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Question Details
- Category: LPN Nursing Exam(s)
- Subcategory: LPN ATI Exit Exam(s)
- Domain: Exit Exam(s)~2025
- Answer Choices: 4