A client is being prepared for a bedside thoracentesis for a pleural effusion.
The nurse prepares the client by placing the client in which position?
Fowlers.
Supine.
Prone.
Lithotomy.
The Correct Answer is A
Choice A rationale
For a thoracentesis, the client is typically positioned sitting upright, often leaning forward over a bedside table. This position, which is a variation of Fowler's or orthopneic positioning, allows the ribs to expand and shifts the pleural fluid to the base of the pleural cavity. This makes the fluid more accessible for the physician to drain via the needle while minimizing the risk of accidental lung puncture, as the diaphragm is displaced downward by gravity.
Choice B rationale
The supine position, where the client lies flat on their back, is inappropriate for a thoracentesis. In this position, the pleural fluid spreads out along the posterior aspect of the lung, making it much harder to locate and safely aspirate a significant volume. Furthermore, lying flat can increase respiratory distress for a client who already has a pleural effusion, as the fluid puts more pressure on the lungs and reduces the available space for expansion.
Choice C rationale
The prone position, lying on the stomach, is not used for a bedside thoracentesis. This position would make it extremely difficult for the clinician to access the posterior or lateral chest wall where the procedure is typically performed. It would also severely compromise the client's ability to breathe comfortably during the procedure, as chest expansion is restricted against the bed surface, leading to increased anxiety and potential hypoxia during the invasive needle insertion.
Choice D rationale
The lithotomy position involves the client lying on their back with legs elevated in stirrups. This is used for pelvic, urological, or gynecological procedures and has no relevance to a thoracentesis. Placing a client with a pleural effusion in this position would provide no access to the thoracic cavity and would likely worsen their shortness of breath by increasing venous return to the heart and pushing abdominal contents against the diaphragm, further limiting lung volume.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Oxygen therapy, even at low flow rates like 2 liters per minute, has a significant drying effect on the delicate mucous membranes of the nasal passages. When the nasal mucosa becomes excessively dry, it can lead to crusting, irritation, and even minor bleeding. Adding humidification to the oxygen source introduces moisture into the inhaled gas, which helps to rehydrate the tissues, loosen dried secretions, and prevent further trauma to the nares.
Choice B rationale
Removing the nasal cannula is not a viable priority intervention because the patient was prescribed oxygen therapy for chronic obstructive pulmonary disease. This condition often results in chronic hypoxemia and hypercapnia, requiring a stable fraction of inspired oxygen to maintain adequate systemic oxygenation. Abruptly discontinuing the oxygen could lead to respiratory distress or a drop in arterial oxygen saturation levels, which would jeopardize the patient's respiratory stability and overall clinical safety.
Choice C rationale
Increasing the oxygen flow rate to 5 liters per minute would be counterproductive and potentially dangerous. Higher flow rates without humidification significantly increase the rate of evaporation from the nasal mucosa, which would exacerbate the crusting and bleeding already observed. Furthermore, in patients with chronic obstructive pulmonary disease who may rely on a hypoxic drive to breathe, excessive oxygen administration can suppress the respiratory drive, leading to dangerous carbon dioxide retention and respiratory acidosis.
Choice D rationale
Applying petroleum jelly or other oil-based products to the nostrils while a patient is receiving oxygen therapy is contraindicated due to a significant safety risk. Petroleum is a combustible substance, and in an oxygen-rich environment, it can pose a fire hazard or cause localized burns if an ignition source is present. Additionally, if petroleum jelly is inhaled into the lungs, it can lead to lipid pneumonia, which is a serious inflammatory condition of the lung parenchyma.
Correct Answer is B
Explanation
Choice A rationale
Using a humidifier might assist with airway moisture or comfort, but it does not address the underlying pathophysiology of obstructive sleep apnea. Sleep apnea in obese clients is primarily caused by the physical collapse of the upper airway due to excess adipose tissue in the neck and pharyngeal area. Humidification does nothing to reduce this mechanical obstruction or the resulting apneic episodes. Therefore, this statement indicates a misunderstanding of the structural nature of the sleep disorder.
Choice B rationale
This statement shows an understanding of the treatment for obstructive sleep apnea because weight loss is a primary intervention for obese clients. Excess fat deposits in the soft tissues of the neck narrow the airway and increase the likelihood of collapse during muscle relaxation in sleep. Reducing body mass decreases the pressure on the pharynx, thereby increasing the airway diameter and reducing the frequency of apneic events. Weight loss can significantly improve the apnea-hypopnea index scores.
Choice C rationale
Taking a sleeping pill is dangerous for a client with obstructive sleep apnea and indicates a severe lack of understanding. Sedatives and hypnotics further relax the muscles of the upper airway and suppress the central nervous system's drive to wake up when oxygen levels drop or carbon dioxide levels rise. Normal arterial carbon dioxide is 35 to 45 mmHg. Suppressing the arousal response can lead to prolonged periods of hypoxia and potentially fatal respiratory arrest during sleep.
Choice D rationale
Consuming alcohol before bedtime is contraindicated for clients with sleep apnea. Alcohol acts as a potent central nervous system depressant and a muscle relaxant. Similar to sleeping pills, it causes the muscles of the throat to relax excessively, which worsens the mechanical obstruction of the airway. Alcohol also interferes with the various stages of the sleep cycle and blunts the body's natural protective reflexes that trigger gasping or waking when the airway is blocked.
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