A client with a chest tube after thoracic surgery reports su… | MyMerci
Complications of ProceduresROR
Question
A client with a chest tube after thoracic surgery reports sudden shortness of breath. The drainage system is tipped over on the floor. What should the nurse do first?
1Clamp the chest tube for 30 minutes.
2Leave the room to search for a new drainage unit before assessing the client.
3Strip the tubing vigorously to restart drainage.
4Assess respiratory status and return the drainage system upright below chest level.✓ Correct answer
Explanation
The nurse first assesses the client and restores the drainage system to an appropriate upright position below chest level. Clamping or stripping can create harm and should not be routine. Leaving without assessment delays recognition of respiratory compromise.
In-depth explanation
Clinical Judgment Use the client cues, timing, labs, and safety risks to select the response that best fits Chest tube drainage problem.
Memory Tip Match the strongest cue cluster to the safest nursing judgment.
KR vs US NCLEX items reward cue-based priority thinking rather than isolated recall.
Clinical scenario
Clinical Practice Guide For Chest tube drainage problem, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
Caution Do not choose an action from one isolated cue when the full scenario changes priority or safety.
Key concepts
Chest Tube — A tube placed to remove air or fluid from the pleural space.
Pleural Space — The space between the lung and chest wall.
Drainage System — A collection device that supports chest tube function and monitoring.