# Place the nursing actions in order when the patient-side chest tube disconnects from the drainage unit.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

Place the nursing actions in order when the patient-side chest tube disconnects from the drainage unit.

Connect the tube to the new drainage unit using sterile technique and restore the prescribed settings.

Reassess the client and system for dyspnea, air leak, tidaling, and drainage, then document the event and response.

Notify the provider and obtain a new sterile drainage unit while maintaining the temporary water seal.

Assess respiratory effort, oxygen saturation, lung sounds, chest symmetry, and signs of a worsening pneumothorax.

Call for assistance and immediately place the distal patient-side tube end in sterile water or saline to create a temporary water seal.

## Explanation

Create a temporary water seal immediately and summon help, then assess for respiratory compromise. Replace the drainage unit using sterile technique, restore ordered settings, and reassess both the client and the system. Routine prolonged clamping is avoided because trapped pleural air can cause tension pneumothorax.

## In-depth explanation

Correct sequence
Temporary water seal → respiratory assessment → obtain replacement → reconnect → reassess and document.

Why this is correct
A disconnected patient-side tube can permit air to enter the pleural space. Sterile water or saline provides a temporary one-way seal while assistance and replacement equipment arrive. Client assessment follows immediately because falling oxygen saturation, asymmetric movement, hypotension, or increasing dyspnea may indicate a pneumothorax.

NCLEX decision rule
Distinguish a tube disconnected from the drainage unit from a tube pulled out of the chest; the emergency response is different.Reference
1NCBI Bookshelf: Manage Chest Tube Drainage Systems

## Clinical scenario

Chest-tube system disconnection
The tube remains secured in the client's chest, but its distal end is no longer connected to the drainage unit. The client is awake and breathing spontaneously. Follow agency policy and the drainage-system manufacturer's instructions.

## Key concepts

- **Water Seal** — A one-way liquid barrier that allows pleural air to leave while limiting air entry.
- **Tension Pneumothorax** — Progressive pressure from trapped pleural air that impairs ventilation and circulation.
- **Air Leak** — Bubbling that may indicate air movement in the system.

## Related questions

- [A nurse cares for a client 12 hours after thoracotomy with a chest tube connected to a wet…](https://mymerci.kr/pages/nclex_q.php?qn_id=366310&lang=en)
- [A nurse is caring for a 64-year-old client 2 hours after a diagnostic cardiac catheterizat…](https://mymerci.kr/pages/nclex_q.php?qn_id=368186&lang=en)
- [A patient on mechanical ventilation has bilateral infiltrates on chest x-ray, no signs of …](https://mymerci.kr/pages/nclex_q.php?qn_id=372717&lang=en)
- [A 38-week newborn is delivered limp, apneic, and cyanotic. Place the steps of Neonatal Res…](https://mymerci.kr/pages/nclex_q.php?qn_id=372738&lang=en)
- [A 64-year-old patient three days post-MI has BP 84/62, HR 124, distant heart sounds, jugul…](https://mymerci.kr/pages/nclex_q.php?qn_id=372747&lang=en)
- [A patient is one day post-thoracotomy with a chest tube connected to a closed-chest draina…](https://mymerci.kr/pages/nclex_q.php?qn_id=372755&lang=en)
- [A nurse is implementing an evidence-based surgical site infection (SSI) prevention bundle …](https://mymerci.kr/pages/nclex_q.php?qn_id=372764&lang=en)
- [A 64-year-old patient is post-op day 6 from a small bowel resection. The nurse notes the a…](https://mymerci.kr/pages/nclex_q.php?qn_id=372799&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=396404&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._