# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396609&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## 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?

## Option

1. Clamp the chest tube for 30 minutes.
2. Leave the room to search for a new drainage unit before assessing the client.
3. Strip the tubing vigorously to restart drainage.
4. Assess respiratory status and return the drainage system upright below chest level. **✔ Correct answer**

**Correct answer: 4**

## 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.

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