A nurse is caring for a client following the placement of a chest tube drainage system for a pneumothorax. Which of the following findings should the nurse expect?

Serous drainage noted in the collection chamber

Tidaling in the water seal chamber with respirations

Diminished breath sounds in the lung bases

Movement of the trachea toward the unaffected side

Answer and Explanation

The Correct Answer is B

A. Serous drainage noted in the collection chamber: The type of drainage typically seen with a pneumothorax is not serous; it is usually minimal or absent. If there is significant drainage, it could indicate bleeding or another issue that should be monitored.

B. Tidaling in the water seal chamber with respirations: Tidaling, or the movement of the water level in the water seal chamber with respirations, is a normal finding. It indicates that the chest tube is correctly placed, and the lung is expanding and contracting.

C. Diminished breath sounds in the lung bases: Diminished breath sounds are expected in the area where the pneumothorax occurred, but it does not specifically indicate the placement of the chest tube.

D. Movement of the trachea toward the unaffected side: Tracheal deviation toward the unaffected side is a sign of tension pneumothorax, which is a medical emergency. It should not be expected following the placement of a chest tube for a pneumothorax, as the goal of the chest tube is to resolve the pneumothorax and prevent complications.

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Correct Answer is B

Explanation

A. Hgb 11.5 g/dL (12 to 16 g/dL): While this hemoglobin level is slightly below normal, it is not an immediate priority compared to other more concerning values. Anemia could be addressed later with appropriate interventions but is not life-threatening in this case.

B. Creatinine 3.2 mg/dL (0.5 to 1.1 mg/dL): A creatinine level of 3.2 mg/dL is significantly elevated and indicates possible kidney dysfunction or acute kidney injury. Gentamicin is known to be nephrotoxic, and this level requires prompt attention to prevent further renal damage.

C. Sodium 146 mEq/L (136 to 145 mEq/L): Sodium levels are only slightly elevated and do not represent an immediate concern unless the client has symptoms of hypernatremia (e.g., confusion, seizures). While monitoring is required, it is not as urgent as the creatinine.

D. WBC count 12,000/mm3 (5,000 to 10,000/mm3): A WBC count of 12,000/mm3 is mildly elevated, which could suggest an infection or inflammation. However, this is not the priority compared to the kidney function, which could be compromised by gentamicin therapy.

A. "Plan to void every 6 hours." B. "Squeeze your legs together when you feel the urge to void." C. "Perform Kegel exercises three times daily." D. "Drink 1 liter of fluids a day."

Correct Answer is C

Explanation

A. "Plan to void every 6 hours.": Voiding every 6 hours may not be appropriate for clients with stress incontinence. A more individualized schedule based on the client's needs and fluid intake is better. Holding urine for too long could worsen symptoms.

B. "Squeeze your legs together when you feel the urge to void.": This is not effective in managing stress incontinence. Instead, strategies like pelvic muscle exercises (Kegel exercises) can help strengthen the muscles that control urination.

C. "Perform Kegel exercises three times daily.": Kegel exercises help strengthen the pelvic floor muscles, which can reduce stress incontinence by improving bladder control. This is an effective and recommended strategy for managing the condition.

D. "Drink 1 liter of fluids a day.": Restricting fluids can concentrate urine, irritating the bladder and worsening incontinence. It’s generally better to maintain adequate hydration, typically around 2 liters of fluids daily, unless otherwise directed by the healthcare provider.

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