Question Scenario Instructions Question & Answer Guide (With Explanation)

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Original Question

NGN Question Scenario Instructions Use the scenario below to answer question below. A 53-year-old client undergoes a right lung wedge resection to remove a tumor. Biopsy results are pending but the tumor has caused moderate to severe pain in the right lung area. The client has no history of cancer and reports no history of cancer in the family. The client reports being a nurse and works at a home health agency as a visiting nurse. The medical history includes hyperlipidemia and taking atorvastatin 40 mg daily. No other medical or surgical history reported. Nurses’ Notes 1100: Client was admitted to medical-surgical unit from the recovery unit following right wedge resection with one chest tube attached to a 3-chamber closed chest tube drainage system. Dressing covering the chest tube insertion site is occlusive, dry, and intact. 50 mL bloody drainage in the collection chamber, intermittent bubbling in the water seal chamber, gentle bubbling in the suction control chamber. Arousable and oriented, oxygen via NC at 2 L/ min, HOB at 30 degrees. VS T = 98.6°F (37.0°C); HR = 80 BPM; RR = 20 bpm; BP 118/70 mm Hg. SpO2 = 95% on 2 L oxygen. Pain 3/10 right chest tube insertion site, increases with deep breathing and coughing. 1200: The nurse notes that the client has dyspnea and reports an increase in pain to 5/10. Drainage in the collection control chamber is at 100 mL bloody drainage; there is continuous vigorous bubbling in the water seal chamber and gentle bubbling in the suction control chamber. Pick from the selection below on what belong on [Action to take] – Pick two. [Condition most likely experiencing] – Pick one. [Parameters to monitor] – Pick two. Options: – Clamp the tubing and determine location of the problem – Apply pressure to the chest tube insertion site – Disconnect and submerge the chest tube in a bottle of sterile water – Respiratory status, HR, BP, RR, SpO2 – Drainage amount in the collection chamber – Hemoglobin, hematocrit, platelets, red blood cells – Air leak in the drainage system – Bleeding – Displacement of the chest tube in the pleural space – Lung has reexpanded – Check for subcutaneous emphysema – Disconnect and submerge the chest tube in a bottle of sterile water – Notify the surgeon – Fluctuation and bubbling in the water seal chamber – Chest x-ray – Drainage amount in the collection chamber

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