Adult chest tube (Management of Care) NCLEX Practice Questions

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Question:

A nurse is assisting a provider with the removal of a chest tube. Which of the following nursing interventions is the priority once the provider removes the tube from the chest?

Answer:

A) Applying an occlusive dressing

Rational:

Placing an occlusive dressing over the site to seal the hole is the top priority after chest tube removal. If the hole is not covered, the client could develop a new pneumothorax and quickly become unstable. This is different than placing a three-sided dressing if the tube becomes dislodged. If the tube is being electively removed, that means the client no longer has a pneumothorax and the chest cavity needs to be sealed off to heal. If the tube is dislodged while the client still has a pneumothorax, the three sided dressing will serve as a one-way valve to allow that air to continue to escape like it would have through the chest tube. Regarding B, this is important, but the client could become quickly unstable or develop a pneumothorax if an occlusive dressing is not placed. This should be done FIRST, before assessing lung sounds. Regarding C, The site can be cleansed thoroughly before tube removal, then according to dressing change orders when it is safe to do so. Regarding D, This is not necessary unless infection is suspected, which was not described in the stem. Even then, it would not occur immediately as applying an occlusive dressing should be done immediately to prevent pneumothorax.

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