The nurse is evaluating interventions for a patient who had a chest tube placed one hour ago for a right sided pneumothorax. Which of the following findings would indicate a need for further intervention?

Decreased breath sounds on the right

Continuous bubbling in the water seal chamber

Absence of tidaling in the water seal chamber

A lack of drainage in the collection chamber

Answer and Explanation

The Correct Answer is A

A. Decreased breath sounds on the right: Persistently decreased or absent breath sounds on the side of the pneumothorax after chest tube placement suggests that the lung may not have fully re-expanded or there may be obstruction, malposition, or kinking of the tube. This finding requires immediate reassessment and intervention to ensure effective lung re-expansion and adequate ventilation.

B. Continuous bubbling in the water seal chamber: Continuous bubbling may indicate an air leak, which is common immediately after chest tube insertion for pneumothorax. While it should be monitored, early continuous bubbling is expected and does not necessarily require urgent intervention unless it persists beyond the initial period or worsens.

C. Absence of tidaling in the water seal chamber: Tidaling reflects normal respiratory fluctuations in intrathoracic pressure. The absence of tidaling may indicate lung re-expansion, which is a desired outcome, or an obstruction in the tubing. The nurse should assess for tube patency, but this finding alone does not always indicate immediate danger.

D. A lack of drainage in the collection chamber: Minimal drainage is expected in a simple pneumothorax because the primary goal is evacuation of air, not fluid. Lack of drainage in the collection chamber immediately post-insertion is generally not concerning and does not require urgent intervention.

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Correct Answer is C

Explanation

A. pH 7.37, PaCO2 36, HCO3- 20, SaO2 92%: This ABG shows normal pH and CO2 levels with slightly low bicarbonate and oxygen saturation. These values do not reflect the hypoventilation present in a patient with shallow respirations at 8 breaths per minute, as CO2 would be expected to rise and pH to fall.

B. pH 7.53, PaCO2 35, HCO3- 28, SaO2 90%: This ABG indicates alkalosis with normal CO2 and slightly elevated bicarbonate, consistent with metabolic alkalosis rather than respiratory compromise. A patient with severe hypoventilation would not present with alkalemia or low-normal PaCO2.

C. pH 7.28, PaCO2 53, HCO3- 22, SaO2 89%: This ABG demonstrates respiratory acidosis with hypoxemia, which is consistent with hypoventilation from shallow respirations. The elevated PaCO2 indicates CO2 retention, the low pH shows acidemia, and the reduced SaO2 reflects impaired oxygenation, all expected in chest trauma with inadequate ventilation.

D. pH 7.44, PaCO2 52, HCO3- 34, SaO2 94%: This ABG shows compensated respiratory acidosis with elevated bicarbonate and a near-normal pH. Compensation would not occur immediately in acute trauma; therefore, this pattern does not match the patient’s acute presentation of shallow respirations and impending respiratory failure.

A. Hemoglobin 20 g/dL (reference range 13.5-18 g/dL) B. Prothrombin time (PT) 10 seconds (reference range 12-15 seconds) C. Activated Partial thromboplastin time (aPTT) 89 seconds (reference range 52.5-87.5 seconds) D. Platelets 455,000/mm3 (reference range 150,000-400,000/mm3)

Correct Answer is C

Explanation

A. Hemoglobin 20 g/dL (reference range 13.5-18 g/dL): Elevated hemoglobin indicates hemoconcentration or polycythemia but does not directly influence heparin dosing. While high hemoglobin may affect blood viscosity, it is not a parameter used to titrate anticoagulation therapy.

B. Prothrombin time (PT) 10 seconds (reference range 12-15 seconds): PT evaluates the extrinsic coagulation pathway and is primarily used to monitor warfarin therapy, not IV heparin. A PT of 10 seconds is slightly below normal, but it does not indicate the need to adjust heparin infusion rates.

C. Activated Partial thromboplastin time (aPTT) 89 seconds (reference range 52.5-87.5 seconds): The aPTT measures the intrinsic and common coagulation pathways and is the standard parameter for titrating IV heparin. An aPTT above the therapeutic range indicates an increased risk of bleeding, requiring the nurse to decrease the heparin infusion.

D. Platelets 455,000/mm3 (reference range 150,000-400,000/mm3): Elevated platelet count (thrombocytosis) does not necessitate adjustment of heparin dosing. Heparin-induced thrombocytopenia would warrant monitoring, but in this case, platelets are elevated rather than decreased, so no immediate titration is indicated.

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The nurse is evaluating interventions for a patient who had a chest tube placed one hour ago for a right sided pneumothorax. Which of the following findings would indicate a need for further intervention?

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