A client has a left chest tube placed yesterday for a spontaneous pneumothorax. It is connected to a drainage system at -20 cm H2O wet suction. At 0800, the water-seal chamber showed tidaling with no bubbling. At 1000, after the client was helped into a chair, the nurse notes continuous bubbling in the water-seal chamber. Tidaling is present, SpO2 is 95% (96% at 0800), RR is 18/min, and the client denies new shortness of breath. A length of tubing hangs in a loop below the chair seat. Which actions should the nurse take? Select all that apply.

Quick answer
Check the connections and dressing, remove the dependent loop, and reassess breath sounds and respiratory effort (options 5, 3, 1).

Why this is correct
The trend matters: no bubbling at 0800 and continuous bubbling right after a transfer suggests the system was disturbed, so the connections and the insertion-site dressing are the first places to look. A dependent loop lets fluid collect in the tubing and impairs drainage, so the tubing is laid out without a loop. Because a new leak can also come from the lung, the nurse reassesses breath sounds and effort; SpO2 and RR are stable, so there is time for systematic checking.

Easy analogy or mental picture
Bubbling that starts right after the furniture moved is like a garden hose that starts spraying after someone stepped on it: check the couplings before blaming the tap.

Memory hook
New bubbling after a move: check the joints, straighten the line, listen to the lungs; never clamp, strip, or shut it off.

NCLEX decision rule
When a drainage system changes after a mechanical event, inspect the system and reassess the client before any intervention that blocks drainage.

Why the other choices are wrong
Clamping near the chest wall (option 2) is tempting because it is still taught as a way to locate a leak or 'stop' air, but prolonged clamping with an ongoing air leak can cause a tension pneumothorax; brief clamping is done only when ordered. Stripping the tubing (option 6) is an older practice to keep tubes patent, but it creates very high negative pressure and can injure tissue; it is not done routinely. Turning off suction (option 4) seems to stop the bubbling, but the bubbling shows air escaping, and removing suction may let air accumulate in the pleural space.