A 55-year-old patient with a chest tube for pneumothorax suddenly pulls out the drainage system while repositioning in bed. What should be the priority nursing action?

Appeared in: NORCET 9 Mains - 2025

Explanation

The phrase 'pulls out the drainage system' signifies the complete dislodgement of the chest tube from the patient's chest wall, creating an open wound.
This event poses an immediate risk of air entering the pleural space, which can quickly lead to a tension pneumothorax, a life-threatening emergency.
The priority is to seal the opening to prevent air entry. Applying a sterile, occlusive dressing, ideally taped on three sides, creates a one-way valve that lets trapped air out but keeps outside air from getting in.
This action directly addresses the most immediate life-threatening risk associated with chest tube removal.

Option A: The chest tube is no longer in the pleural space, so applying suction is futile and does not address the open wound in the chest wall.
Option C: This action is for a different emergency. It is the correct response if the chest tube disconnects from the drainage collection unit, but not when the tube is pulled out of the body.
Option D: There is no tube to clamp since it has been removed from the patient's chest. Furthermore, clamping a chest tube is generally contraindicated.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Priority nursing action for accidental chest tube removal in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's ability to instantly differentiate between chest tube dislodgement and system disconnection is critical. The wrong action can be fatal.
Emergency supplies, including sterile occlusive dressings (petrolatum gauze), sterile water, and padded clamps, should always be kept at the bedside of a patient with a chest tube.
After applying the dressing, the nurse must continuously monitor the patient for signs of respiratory distress, which could indicate a developing tension pneumothorax, and notify the provider immediately.

How to Approach the Question

First, identify the question as a clinical scenario requiring a priority nursing action.
Carefully read the stem and identify the key event: the patient 'pulls out the drainage system'. Interpret this to mean the tube is completely dislodged from the chest.
Consider the immediate physiological threat: an open wound into the pleural space allows air to enter, risking lung collapse and tension pneumothorax.
Evaluate each option based on its ability to mitigate this primary threat.
Eliminate the option for a disconnected system (submerging in water) as it doesn't match the event.
Eliminate options that are impossible or irrelevant (clamping a non-existent tube, applying suction to an open wound).

Concept Tested & Keywords

Concept Tested: Priority nursing action for accidental chest tube removal
Stem keywords: chest tube, pneumothorax, pulls out, drainage system, priority nursing action
Lead-in keywords: priority
Clinical cues: The phrase 'pulls out the drainage system' implies complete dislodgement from the chest, which is a critical detail.

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E6 Nursing Fundamentals Taylor p. 734-736

E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 35-37, 2-4

Practise the full NORCET 9 Mains - 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.