Progressive Care Nursing Certification (PCCN) Practice Exam

What should a nurse do if they observe tidaling in a patient's chest tube with a persistent pneumothorax?

1. Continue to observe

2. Check the tubing for kinks

3. Milk or strip the chest tube

4. Clamp the chest tube and notify the surgeon

The correct answer is: Continue to observe

In the context of a patient with a persistent pneumothorax, observing tidaling in the chest tube is an important indicator of the dynamics between intrathoracic pressure and the patient's respiratory function. Tidaling, which is the fluctuation of water in the water-seal chamber with respiration, suggests that the chest tube is functioning properly and is allowing for air to exit the pleural space during inhalation and preventing return during exhalation. This observation is critical because it indicates that there is still some residual negative pressure within the pleural space, even though the pneumothorax persists. In such a situation, the next steps typically involve careful monitoring rather than immediate intervention. Continuous observation allows the nurse to assess ongoing respiratory status and the effectiveness of the chest tube drainage. If there are changes in respiration, increased distress, or other concerning signs, further assessment and intervention may be warranted. The other options, while they involve actions that could be taken in response to certain issues with a chest tube, do not align as appropriately with the observation of tidaling. For example, checking for kinks in the tubing might be relevant if there is no tidaling or if drainage has stopped; however, if tidaling is present, it's less likely that k