How chest tubes are tested on the NCLEX-RN
Items fall under Reduction of Risk Potential and Physiological Adaptation.
Expected vs concerning findings
Much of chest tube care is interpreting what you see.
| Routine care | Rationale |
|---|---|
| Keep the unit upright and below chest level | Prevents backflow into the pleural space |
| Avoid dependent loops and kinks | Allows drainage and air to exit |
| Mark drainage level and time on the unit | Tracks output |
| Assess the insertion site and dressing | Detects infection or leak |
| Encourage deep breathing, coughing, incentive spirometry | Promotes lung re-expansion |
| Keep sterile water and an occlusive dressing at the bedside | For emergencies |
Routine stripping or milking of tubes is not recommended unless ordered.
Emergencies
Two scenarios are tested repeatedly.
Pneumothorax and tension pneumothorax
Know which findings signal a life-threatening emergency.
| Type | Findings | Nursing priority |
|---|---|---|
| Spontaneous (often tall, thin, young adults; smokers) | Sudden one-sided chest pain, dyspnea, decreased breath sounds | Oxygen, prepare for chest tube or aspiration |
| Tension | Severe distress, hypotension, JVD, tracheal deviation away from affected side, absent breath sounds, tachycardia | Emergency: call for help; prepare for needle decompression then chest tube |
| Open (sucking chest wound) | Air entering through a chest wall wound | Cover with a vented or three-sided occlusive dressing per protocol |
Tracheal deviation is a late sign of tension pneumothorax.
NGN-style case
Linking a chest tube finding to the next step.
A client with a chest tube for pneumothorax becomes acutely short of breath. BP 82/48, HR 132, trachea shifted to the right, and breath sounds absent on the left. Tidaling has stopped and the tube is kinked under the client. What should the nurse do?
- Recognize cues: hypotension, tachycardia, tracheal shift away from the left, absent breath sounds, stopped tidaling, kinked tube.
- Analyze: tension pneumothorax, likely from the obstructed tube.
- Relieve the kink immediately and call the rapid response team.
- Give oxygen, stay with the client, and prepare for emergency decompression if it does not resolve.
Answer. Unkink the tube, call for emergency help, and support oxygenation. This is a tension pneumothorax.