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    Ati rn adult medical surgical 2023 proctored exam

    A nurse is caring for a client who has a chest tube in the pleural space. The nurse notices continuous bubbling in the water seal chamber of the client's drainage system. Which of the following actions should the nurse take?

    Explanation & Rationale

    A. Gently squeeze the tubing to remove excess drainage: Squeezing the tubing is not recommended as it could cause injury or increase pressure within the system. The nurse should not manipulate the tubing in this way, as it does not address the continuous bubbling. B. Raise the drainage system to the client's chest level: The drainage system should always be below the level of the client's chest to promote proper drainage. Raising the system to chest level could disrupt the drainage process and cause complications. C. Clamp the tubing to check for air leaks: Continuous bubbling in the water seal chamber may indicate an air leak in the system. The nurse should clamp the tubing temporarily to isolate the source of the leak and check for any external leaks or loose connections. D. Empty the collection chamber: The collection chamber should only be emptied when it is full. Continuous bubbling in the water seal chamber is more likely an indication of an air leak. The nurse should first assess for leaks before considering emptying the chamber.

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