A client with exacerbation of chronic obstructive pulmonary disease (COPD) is scheduled for a thoracentesis. Which nursing intervention would be appropriate for client safety?
Administering a cough suppressant as needed.
Assisting the client to a prone position.
Obtaining arterial blood gas values immediately after the procedure.
Applying oxygen via nasal cannula.
The Correct Answer is D
Choice A reason: Cough suppressants may reduce discomfort but don’t address hypoxia risk during thoracentesis in COPD exacerbation. Oxygen application ensures safety, making this incorrect, as it doesn’t prioritize respiratory support needed for the client undergoing a procedure affecting lung function.
Choice B reason: A prone position is unsafe for thoracentesis, which requires an upright or side-lying position to access pleural fluid. Oxygen supports breathing, making this incorrect, as it risks procedural complications compared to ensuring oxygenation for the COPD client’s safety.
Choice C reason: Arterial blood gases post-procedure assess respiratory status but aren’t the primary safety intervention during thoracentesis. Oxygen prevents hypoxia, making this secondary and incorrect compared to the immediate need for respiratory support in the COPD client undergoing the procedure.
Choice D reason: Applying oxygen via nasal cannula ensures adequate oxygenation during thoracentesis, critical for a COPD client with exacerbation prone to hypoxia. This aligns with procedural safety protocols, making it the correct intervention to maintain client safety during the pleural fluid removal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Leafy greens contain iron, but water doesn’t enhance absorption; vitamin C does. Calf’s liver with orange juice maximizes absorption, making this incorrect, as it lacks the vitamin C component the nurse should teach to improve iron uptake in anemia.
Choice B reason: Apples and carrots have minimal iron and no vitamin C to enhance absorption. Calf’s liver with orange juice is optimal, making this incorrect, as it doesn’t provide iron or absorption enhancers compared to the nurse’s teaching for iron deficiency anemia.
Choice C reason: Steak is iron-rich, but mushrooms don’t significantly enhance absorption like vitamin C. Orange juice with liver is better, making this incorrect, as it’s less effective than the nurse’s recommendation to pair iron with a vitamin C source for anemia.
Choice D reason: Calf’s liver is high in iron, and orange juice’s vitamin C enhances non-heme iron absorption. This aligns with nutritional education for iron deficiency anemia, making it the correct choice for the nurse to teach the client to improve iron absorption effectively.
Correct Answer is B
Explanation
Choice A reason: Shortness of breath is a heart failure symptom, not a furosemide side effect, which causes diuresis. Lightheadedness from hypotension is common, making this incorrect, as it confuses disease symptoms with medication effects in the nurse’s monitoring plan for furosemide.
Choice B reason: Lightheadedness is a common furosemide adverse effect due to hypotension or electrolyte imbalances from diuresis. This aligns with pharmacological monitoring for heart failure treatment, making it the correct effect the nurse should plan to monitor in the client.
Choice C reason: Dry cough is associated with ACE inhibitors, not furosemide, a diuretic causing hypotension. Lightheadedness is a furosemide effect, making this incorrect, as it misattributes a side effect to the wrong medication in the nurse’s monitoring for heart failure treatment.
Choice D reason: Bitter taste is not a typical furosemide side effect; it’s more linked to medications like antibiotics. Lightheadedness is relevant, making this incorrect, as it does not reflect the expected adverse effects the nurse should monitor with furosemide administration.
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