Increased heart rate.
Discomfort at the puncture site.
A nurse is monitoring a client following a thoracentesis. The nurse should identify which of the following manifestations as a complication and contact the provider immediately?
Decreased temperature.
Serosanguineous drainage from the puncture site.
Shortness of breath.
Chest pain.
The Correct Answer is C
Choice A rationale
Decreased temperature is not typically an immediate complication following a thoracentesis. It may indicate an infection, but this would develop over time rather than immediately after the procedure.
Choice B rationale
Serosanguineous drainage from the puncture site is expected after a thoracentesis and does not indicate a complication that requires immediate attention.
Choice C rationale
Shortness of breath is a serious complication that can indicate a pneumothorax or re- accumulation of fluid in the pleural space. This requires immediate attention and intervention by the healthcare provider.
Choice D rationale
Chest pain can be a sign of a complication such as a pneumothorax or infection. However, shortness of breath is a more immediate and severe symptom that requires urgent attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Prostate cancer mortality is more than double for Black American males than for other groups. This is a significant consideration when creating a plan of care for prostate screening in high- risk populations. Black American males have a higher incidence and mortality rate of prostate cancer compared to other racial and ethnic groups. This disparity is attributed to a combination of genetic, socioeconomic, and healthcare access factors. Therefore, targeted screening and early detection efforts are crucial for this high-risk population to improve outcomes and reduce mortality rates.
Choice B rationale
Occupational toxic exposure among factory workers can increase the risk of various cancers, including prostate cancer. However, this is not the most important consideration when creating a plan of care for prostate screening in high-risk populations. While occupational exposure is a risk factor, it does not have the same level of impact on prostate cancer incidence and mortality as race and family history. Screening efforts should prioritize those with the highest risk, such as Black American males and individuals with a family history of prostate cancer.
Choice C rationale
Dietary factors can influence the risk of prostate cancer, but the impact is not as significant as other risk factors such as race and family history. While a healthy diet is important for overall health and may help reduce cancer risk, it is not the primary consideration for prostate screening in high-risk populations. Screening efforts should focus on those with the highest risk based on genetic and demographic factors, rather than dietary habits alone.
Choice D rationale
A computed tomography (CT) scan is not the best way to determine prostate cancer risk. The primary screening method for prostate cancer is the prostate-specific antigen (PSA) blood test, often combined with a digital rectal exam (DRE). CT scans are not typically used for initial screening but may be employed for further evaluation if there are abnormal findings on PSA or DRE. The focus should be on using established screening methods to identify high-risk individuals and provide early detection and intervention.
Correct Answer is D
Explanation
Choice A rationale
Reviewing laboratory test results for low hemoglobin is important for monitoring anemia, which can be a side effect of radiation therapy. However, it is not the most immediate action to address the specific side effects of radiation therapy to the lung, such as xerostomia (dry mouth) and skin reactions.
Choice B rationale
Assessing the skin for erythema is important as radiation therapy can cause skin reactions, including redness and irritation. However, this action does not directly address the management of xerostomia, which is a common side effect of radiation therapy to the head and neck areas.
Choice C rationale
Monitoring the client for signs of fatigue is essential as fatigue is a common side effect of radiation therapy. However, this action does not specifically address the management of xerostomia, which requires targeted oral care.
Choice D rationale
Providing oral care to manage xerostomia is the correct action. Xerostomia, or dry mouth, is a common side effect of radiation therapy, especially when the head and neck are involved. Oral care helps to alleviate discomfort, prevent infections, and maintain oral health.
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