Nokea
The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?
- A. Supine with the head of the bed elevated 30 degrees
- B. In a high-Fowler's position with the left arm extended
- C. On the right side with the left arm extended above the head
- D. Sitting upright with the arms supported on an overbed table
Correct Answer: D
Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.
You may also like to solve these questions
The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use?
- A. I have not had any acute asthma attacks during the last year.
- B. I became short of breath an hour before coming to the hospital.
- C. I've been taking Tylenol 650 mg every 6 hours for chest-wall pain.
- D. I've been using my albuterol inhaler more frequently over the last 4 days.
Correct Answer: D
Rationale: The correct answer is 'I've been using my albuterol inhaler more frequently over the last 4 days.' This statement indicates that the patient may need teaching regarding medication use because an increased need for a rapid-acting bronchodilator suggests an exacerbation of asthma. The patient should be educated on recognizing worsening symptoms and the appropriate actions to take. Choices A, B, and C do not directly relate to asthma exacerbation or the need for medication teaching, making them incorrect. Choice A reflects a lack of recent acute asthma attacks, while choice B describes shortness of breath unrelated to medication use. Choice C mentions Tylenol use for chest-wall pain, which is not indicative of asthma exacerbation or medication teaching needs.
Using the illustrated technique, the healthcare provider is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)?
- A. Hyperresonance
- B. Tripod positioning
- C. Accessory muscle use
- D. Reduced chest expansion
Correct Answer: D
Rationale: The technique for palpation for chest expansion is shown in the illustrated technique. Reduced chest expansion would be noted on palpation of a patient's chest with COPD. Hyperresonance would be assessed through percussion, not palpation. Accessory muscle use and tripod positioning would be assessed by inspection, not palpation.
When caring for a patient hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of the patient. Which action, if performed by the student nurse, would require an intervention by the nurse?
- A. The patient is offered a tissue from the box at the bedside.
- B. A surgical face mask is applied before visiting the patient.
- C. A snack is brought to the patient from the unit refrigerator.
- D. Hand washing is performed before entering the patient's room.
Correct Answer: B
Rationale: When caring for a patient with active tuberculosis (TB), it is crucial to use a high-efficiency particulate-absorbing (HEPA) mask instead of a standard surgical mask when entering the patient's room, as a HEPA mask can filter out 100% of small airborne particles, reducing the risk of transmission. Therefore, if the student nurse applies only a surgical face mask before visiting the patient, this action would require intervention by the nurse to ensure the appropriate protective equipment is used. Hand washing before entering the patient's room is essential to prevent the spread of infection and is a correct action. Bringing a snack to the patient from the unit refrigerator is appropriate and helps address potential issues with anorexia and weight loss in patients with TB. While hand washing after handling a tissue used by the patient is necessary, no special precautions are required when offering the patient an unused tissue.
A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6°F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first?
- A. Codeine
- B. Guaifenesin (Robitussin)
- C. Acetaminophen (Tylenol)
- D. Piperacillin/tazobactam (Zosyn)
Correct Answer: D
Rationale: The correct answer is Piperacillin/tazobactam (Zosyn). Early initiation of antibiotic therapy is crucial in cases of community-acquired pneumococcal pneumonia to reduce mortality. While providing symptomatic relief with medications like Codeine for cough, Guaifenesin for mucus clearance, and Acetaminophen for fever and pain is important, the priority should be to start antibiotic therapy to target the underlying infection. Piperacillin/tazobactam is an appropriate choice for treating severe community-acquired pneumonia caused by pneumococcal organisms.
Which intervention will the nurse include in the plan of care for a patient diagnosed with a lung abscess?
- A. Teach the patient to avoid using over-the-counter expectorants.
- B. Assist the patient with chest physiotherapy and postural drainage.
- C. Notify the healthcare provider immediately regarding any bloody or foul-smelling sputum.
- D. Teach about the necessity of prolonged antibiotic therapy after discharge from the hospital.
Correct Answer: D
Rationale: For a patient diagnosed with a lung abscess, the priority intervention is to educate them about the importance of prolonged antibiotic therapy post-hospital discharge. Long-term antibiotic treatment is crucial for eradicating the infecting organisms in a lung abscess. Chest physiotherapy and postural drainage are not recommended for lung abscess as they can potentially spread the infection. While foul-smelling and bloody sputum are common in lung abscess, immediate notification to the healthcare provider is essential. Avoiding the use of over-the-counter expectorants is not necessary, as expectorants can be used to facilitate coughing and clearing of secretions in this condition.