Lung Cancer with Thoracentesis

A nurse is caring for a 75-year-old male client in the medical-surgical unit who is experiencing difficulty breathing and shortness of breath following a thoracentesis.

The nurse is caring for the client following a thoracentesis. Select the 3 findings that require immediate follow-up.

Choice A rationale

Packed RBCs are administered to increase oxygen-carrying capacity in cases of significant blood loss or severe anemia. While bleeding is a concern in hemophilia A, the primary issue is the lack of clotting factor VIII, not a deficiency in red blood cells per se, making this a secondary intervention if severe bleeding occurs.

Choice B rationale

Fresh frozen plasma contains all coagulation factors, but its use is less specific and carries a higher risk of volume overload and transfusion reactions compared to targeted factor replacement. Recombinant antihemophilic factor provides the specific missing factor VIII without the risks associated with plasma.

Choice C rationale

Prophylactic antibiotics are given to prevent bacterial infections, particularly in surgical procedures where there is a risk of contamination. While general surgical principles might involve antibiotics, the immediate and primary concern for an adolescent with hemophilia A undergoing extractions is preventing excessive bleeding due to the clotting factor deficiency.

Choice D rationale

Hemophilia A is characterized by a deficiency of functional factor VIII. Recombinant antihemophilic factor is a genetically engineered product that provides the missing clotting factor, directly addressing the underlying hemostatic defect. Administering this product pre-procedure ensures adequate clotting factor levels to prevent excessive bleeding during the wisdom teeth extractions.

Choice A rationale

Alteplase (tPA) is a thrombolytic agent, meaning it dissolves existing blood clots by activating plasminogen to form plasmin, which then breaks down fibrin. It is used to treat acute thrombotic events like pulmonary embolism or ischemic stroke, but it is not typically used for prophylactic prevention of DVT due to its significant bleeding risk.

Choice B rationale

Enoxaparin is a low molecular weight heparin (LMWH). It exerts its anticoagulant effect primarily by potentiating the action of antithrombin on Factor Xa, thereby inhibiting the coagulation cascade. LMWHs are highly effective and commonly used for the prophylactic prevention of deep vein thrombosis following orthopedic surgeries, including total knee replacement, due to their predictable pharmacokinetics.

Choice C rationale

Warfarin is an oral anticoagulant that works by inhibiting vitamin K epoxide reductase, an enzyme necessary for the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X). While effective for long-term anticoagulation, its delayed onset of action and need for frequent INR monitoring make it less suitable for immediate postoperative DVT prophylaxis compared to LMWHs.

Choice D rationale

Clopidogrel is an antiplatelet agent that works by selectively inhibiting the binding of adenosine diphosphate (ADP) to its receptor on platelet surfaces, thereby preventing platelet activation and aggregation. It is used to prevent arterial thrombotic events like myocardial infarction and stroke, but it is not the primary medication for preventing venous thromboembolism such as DVT.