A nurse is caring for a client following the placement of a chest tube drainage system for a pneumothorax. Which of the following findings should the nurse expect?

Rationale for correct choices:

• Myocardial infarction: Elevated troponin levels are a specific biomarker for myocardial injury. The client’s Troponin T rose from 0.08 to 0.2 ng/mL, and Troponin I from 0.01 to 0.1 ng/mL, both exceeding normal limits, suggesting ongoing cardiac muscle damage consistent with a myocardial infarction.
• Troponin levels: Troponins are proteins released into the bloodstream when cardiac muscle is injured. A marked rise in both Troponin T and I over a short period indicates acute coronary syndrome progressing to myocardial infarction, especially in a client with chest pain unrelieved by nitroglycerin.

Rationale for incorrect choices:

• Bleeding: The client’s aPTT is 32 seconds and platelet count is 350,000/mm³, both within normal ranges. These do not suggest any coagulopathy or increased bleeding risk, especially prior to thrombolytic therapy.
• Pulmonary embolism: While shortness of breath and anxiety can be symptoms of a pulmonary embolism, the primary lab indicator—rising troponins—points toward cardiac injury. Additionally, pulmonary embolism is typically diagnosed with D-dimer, CT angiography, or V/Q scan, not troponin trends.
• Shortness of breath: Though concerning, shortness of breath is a nonspecific symptom and can occur in multiple conditions including angina, anxiety, and myocardial infarction. It is not the primary diagnostic indicator in this case and does not support a specific risk like the troponin trend does.
• aPTT levels: The client’s aPTT is 32 seconds, which is within the normal reference range of 30–40 seconds. This does not suggest impaired clotting and therefore does not indicate a bleeding risk at this time.

A. Water pitcher on client's bedside table: Water does not require special handling after chemotherapy. The nurse should ensure that the client has access to clean drinking water, but there are no special precautions for handling it.
B. Client's urine in the bedside commode: Client's urine after chemotherapy requires special handling, as it may contain cytotoxic drugs or their metabolites for up to 48 hours. Proper precautions, such as wearing gloves and using appropriate disposal methods, are necessary to avoid exposure.
C. Client's bed linens after use: Bed linens do not require special handling unless contaminated with bodily fluids such as urine or vomit that could contain chemotherapy drugs. Gloves should be worn, but no additional precautions are required unless the linens are contaminated.
D. Food tray and utensils from client's breakfast: Food trays and utensils do not require special handling after chemotherapy unless they are contaminated with body fluids. Normal cleaning and sanitation practices are sufficient.