A patient is returned to the nursing unit after thoracic surgery with chest tubes in place.
During the first few hours postoperatively, what type of drainage should the nurse expect?
Bloody, with frequent small clots.
Serosanguineous.
Serous.
Purulent.
The Correct Answer is A
Choice A rationale
Following thoracic surgery, the surgical incision and surrounding tissues are actively bleeding. It is normal to expect bloody drainage, often with small clots, in the chest tube drainage system during the initial postoperative period (the first few hours). The quantity and color should be monitored closely, as excessive bright red drainage may indicate active hemorrhage, which requires immediate medical intervention.
Choice B rationale
Serosanguineous drainage, a pinkish-red, watery fluid, typically occurs later in the healing process, usually after the first 24-48 hours. It is a mixture of serous fluid and blood, indicating that the initial bleeding has subsided and the wound is beginning to heal. This type of drainage is not characteristic of the immediate postoperative period.
Choice C rationale
Serous drainage is a clear, watery fluid that consists of serum. It is typically seen in the later stages of wound healing, and its presence in a chest tube indicates that the pleural space is no longer bleeding or leaking significant amounts of fluid. Expecting this type of drainage in the immediate postoperative period is incorrect and would suggest a problem with the drainage system.
Choice D rationale
Purulent drainage is thick, cloudy, and often has a foul odor. It contains white blood cells, dead tissue, and bacteria, and is a hallmark sign of infection. The presence of purulent drainage is an abnormal finding at any stage postoperatively and requires immediate medical attention to address the underlying infection. It is never an expected finding in the first few hours after surgery. *.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["5"]
Explanation
The patient has an order for heparin 100 units over one hour. Heparin from the pharmacy comes as 10,000 units in 500 ml. The nurse should set the pump to deliver how many ml/hr?.
Step 1: Calculate the concentration of the heparin solution. 10,000 units ÷ 500 mL = 20 units/mL.
Step 2: Determine the volume of solution required to deliver 100 units. 100 units ÷ (20 units/mL) = 5 mL.
Step 3: The infusion is to be delivered over one hour. 5 mL ÷ 1 hour = 5 mL/hr. The nurse should set the pump to deliver 5 mL/hr.
Correct Answer is D
Explanation
Choice A rationale
Increasing tidal volume would further exacerbate the respiratory alkalosis. Tidal volume, the amount of air moved into and out of the lungs with each breath, directly influences the partial pressure of carbon dioxide ($PaCO_2$). Increasing it would remove more $CO_2$, causing the pH to rise further from the normal range of 7.35-7.45 and $PaCO_2$ to fall below the normal range of 35-45 mmHg. This action is contraindicated as the patient is already alkalotic.
Choice B rationale
Increasing the fraction of inspired oxygen ($FIO_2$) is unnecessary and potentially harmful. The patient's $PaO_2$ is 80 mmHg, which is within the normal range of 80-100 mmHg. Therefore, the patient is not hypoxemic. Increasing oxygen delivery in a patient with COPD can suppress the hypoxic drive to breathe, which is a significant risk for respiratory depression and increased $PaCO_2$ levels. This action would not correct the underlying respiratory alkalosis.
Choice C rationale
Leaving the ventilator at the current settings would be inappropriate because the patient is in respiratory alkalosis. The blood gas results show a pH of 7.50, which is elevated, and a $PaCO_2$ of 29 mmHg, which is low. This indicates that the ventilator settings are causing the patient to hyperventilate and eliminate too much carbon dioxide. Adjustments are necessary to normalize the blood gas parameters and prevent further complications.
Choice D rationale
Decreasing the respiratory rate would be the most appropriate intervention. The patient's blood gas results show respiratory alkalosis (pH 7.50, $PaCO_2$ 29 mmHg), which is caused by the patient breathing too fast and "blowing off" too much $CO_2$. Reducing the respiratory rate will allow $CO_2$ to accumulate, raising the $PaCO_2$ and lowering the pH back toward the normal range (pH 7.35-7.45; $PaCO_2$ 35-45 mmHg). *.
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