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    Ati lpn n113 pharmacology proctored exam

    he nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal chamber. Which is the most appropriate nursing action?

    Explanation & Rationale

    A. Change the chest tube drainage system: Changing the entire drainage system is not warranted for intermittent bubbling in the water seal chamber. This action is appropriate for malfunctioning systems or when there is a significant system compromise such as contamination or leakage. B. Document the findings: Intermittent bubbling in the water seal chamber is an expected finding during active pneumothorax as air escapes from the pleural space. This indicates that the chest tube is functioning, and documenting the observation is the appropriate action. C. Check for an air leak: Continuous, not intermittent, bubbling may indicate an air leak. Intermittent bubbling usually occurs during expiration or coughing and does not require investigation unless it becomes continuous or excessive. D. Notify the health care provider: There is no immediate need to notify the provider for expected intermittent bubbling. This is a normal finding in some phases of pneumothorax resolution and does not indicate a complication requiring urgent intervention.

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