This question tests clinical judgment in recognizing hemorrhage as a post-thoracotomy complication requiring immediate intervention. The priority concern is active bleeding indicated by the sudden increase to 220 mL/hr of bright red drainage, which suggests arterial bleeding or major vessel injury. Reporting the increased bright red drainage (B) is correct because this volume and appearance indicate hemorrhage requiring immediate medical evaluation and possible return to surgery. Oxygen saturation of 92% (A) is slightly low but not immediately life-threatening, elevated vital signs (C) are expected post-operatively and with mild hypoxemia, and the temperature and blood pressure (D) are within normal limits. The decision-making principle is recognizing drainage patterns that indicate hemorrhage versus expected post-operative drainage. When monitoring post-thoracotomy drainage, immediately report outputs exceeding 100 mL/hr after the first 2 hours, sudden increases in drainage, or color changes to bright red.

This question tests clinical judgment in recognizing excessive chest tube drainage requiring immediate intervention. The priority concern is hemorrhage or rapid fluid loss, as 900 mL in the first hour far exceeds the normal expected drainage of 100-300 mL/hr initially. Reporting this finding immediately (C) is correct because excessive drainage can lead to hypovolemic shock and requires urgent medical evaluation and possible surgical intervention. Gentle bubbling in the suction chamber (A) is normal when suction is applied, straw-colored drainage below chest level (B) indicates proper positioning and expected drainage characteristics, and diminished breath sounds at the base (D) are expected with pleural effusion. The decision-making principle is recognizing abnormal drainage volumes that indicate potential hemorrhage or rapid fluid shifts. When monitoring chest tube output, immediately report drainage exceeding 100 mL/hr after the first 2 hours or any sudden increase in bloody drainage.

The correct answer is B. Fluctuation of the water level with respirations, known as tidaling, is an expected finding that indicates the chest tube is patent and functioning properly. A: Continuous bubbling indicates an air leak in the system or from the client. C: Absence of tidaling may indicate that the lung has re-expanded (a desired outcome) or that there is a kink or obstruction in the tubing. D: A high water level is not a specific expected finding and does not indicate proper function.

The correct answer is B. Dependent loops can collect fluid and obstruct the flow of drainage from the pleural space, which can impede lung re-expansion. The priority action is to lift the tubing to allow the fluid to drain into the collection chamber, ensuring the system remains patent. A: Notifying the RN is not the priority; this is a situation the LPN can and should correct. C: Increasing suction will not resolve the obstruction caused by the fluid-filled loop. D: Documentation is necessary, but correcting the problem is the immediate priority.

The correct answer is B. Drainage of more than 100-150 mL/hour of bright red blood, especially after the initial post-operative period, can indicate active bleeding or hemorrhage. The first action is to collect further data, specifically vital signs, to assess for signs of hemodynamic instability (e.g., hypotension, tachycardia). After gathering this critical data, the nurse must immediately report all findings to the RN as this is an abnormal finding requiring immediate attention. A: Simply documenting is unsafe as this finding is abnormal and requires immediate reporting. C: Repositioning does not address the potential for hemorrhage. D: Administering pain medication is not the priority when hemorrhage is suspected.

The correct answer is A. If the chest tube disconnects from the drainage system, the immediate action is to place the end of the tube in a bottle of sterile water or saline. This creates a temporary water seal, which prevents air from entering the pleural space while a new drainage system is prepared. B: Clamping the tube is dangerous and can lead to a tension pneumothorax. C: Reconnecting a contaminated tube introduces pathogens into the pleural space. D: Covering with sterile gauze does not create the necessary water seal to prevent air entry.

The correct answer is C. Continuous bubbling in the water seal chamber indicates a persistent air leak. Since the tube was placed three days ago, the leak should be resolving. Continuous bubbling suggests a new or ongoing leak, which could be from the client or, more commonly, from a loose connection in the system. A: If the lung had re-expanded, tidaling and bubbling would cease. B: Suction level affects the suction control chamber, not the water seal chamber. D: A clot would cause tidaling to stop but would not cause bubbling.

The correct answer is B. The crackling sensation is subcutaneous emphysema (crepitus), which occurs when air leaks from the pleural space into the subcutaneous tissues. The LPN should mark the outer border of the affected area to monitor for any increase in size and immediately notify the RN. This finding can indicate a worsening air leak or a malpositioned tube. A and C do not address the underlying problem. D is incorrect; this is an abnormal finding that requires monitoring and reporting.

The correct answer is A. The cessation of tidaling (fluctuation) combined with respiratory distress suggests an obstruction in the chest tube system. The first action is to quickly assess for and correct any common, reversible causes, such as kinks in the tubing or the client lying on the tube. This simple intervention may resolve the issue immediately. After checking the tubing, the nurse should notify the RN of the findings and the client's respiratory distress. B may be appropriate but does not address the potential cause. C should be done after the quick assessment. D is beyond the LPN's scope and premature.

The correct answer is B. In a wet suction system, the amount of suction is determined by the height of the water column in the suction control chamber, not by the setting on the wall regulator. The provider ordered -20 cm H2O, so the water level should be at the 20 cm mark. Gentle, not vigorous (A), bubbling in this chamber indicates that suction is active. C is incorrect; the water seal chamber is filled only to the indicated line. D is incorrect because the wall suction should be set high enough to produce gentle bubbling, but the wall setting itself does not determine the pressure applied to the client's chest.