The nurse is caring for a client who has a pneumothorax and a water-seal chest tube drainage system to suction. Which of the following actions should the nurse take?

Choice A rationale Emptying the collection container of a chest tube drainage system is incorrect because these systems are designed to be disposable and closed. Opening the system to empty it would break the sterile seal and increase the risk of introducing pathogens into the pleural space, potentially causing empyema. If the collection chamber becomes full, the entire drainage unit must be replaced using sterile technique. The nurse should monitor and mark the drainage levels on the outside of the container. Choice B rationale The drainage system must be maintained below the level of the client's chest to utilize the principle of gravity. Keeping the unit lower than the insertion site prevents the backflow of drainage or air into the pleural space, which could worsen a pneumothorax or lead to infection. Gravity facilitates the movement of air and fluid out of the thoracic cavity into the collection chamber. This positioning is essential for maintaining the pressure gradient necessary for lung re-expansion and safe drainage. Choice C rationale Adding tap water to the suction control chamber is a violation of sterile technique and safety protocols. Only sterile water should be used in the water-seal or suction control chambers to prevent the growth of microorganisms. Furthermore, the suction control chamber regulates the amount of negative pressure applied to the pleural space based on the water level. Using tap water, which contains minerals and impurities, could interfere with the system and introduce contaminants if the system is compromised. Choice D rationale Clamping a chest tube when it becomes disconnected is generally contraindicated because it can lead to a tension pneumothorax. If the tube is clamped, air cannot escape the pleural space, causing pressure to build up and potentially shifting the mediastinum, which is a life-threatening emergency. Instead, the nurse should submerge the end of the chest tube in a bottle of sterile water to create a temporary water seal while preparing a new drainage system for connection.