Your patient comes into the Emergency Room with a chief complaint of dyspnea which is worse upon inspiration.
The patient is diagnosed with a pleural effusion, and the medical doctor wants to do a Thoracentesis. How should you position the patient?
Position patient sitting on the edge of the bed, leaning on a pillow that is on top of the bedside table.
Place the patient in prone position and open the back of their gown.
Have the patient lying supine with arms folded across their chest.
No particular positioning is required.
The Correct Answer is A
Choice A rationale
Positioning the patient sitting on the edge of the bed, leaning on a pillow on the bedside table, is the optimal position for a thoracentesis. This position maximizes the intercostal spaces, allowing for easier access to the pleural cavity while keeping the diaphragm in a lowered position. This widens the spaces between the ribs, facilitating needle insertion and minimizing the risk of injury to surrounding structures like the lungs or diaphragm.
Choice B rationale
Placing the patient in a prone position is contraindicated for a thoracentesis. This position would make accessing the posterior pleural space extremely difficult and unsafe, increasing the risk of accidental organ puncture. It offers no anatomical advantage for the procedure and significantly impedes proper visualization and access to the typical insertion site.
Choice C rationale
Lying supine with arms folded across the chest is not an appropriate position for a thoracentesis. This position would flatten the intercostal spaces, making needle insertion more challenging and increasing the risk of lung puncture. It does not provide optimal access to the pleural cavity for fluid drainage and limits respiratory excursion.
Choice D rationale
Stating no particular positioning is required for a thoracentesis is incorrect and potentially dangerous. Proper positioning is critical for patient safety and procedural success, as it optimizes access to the pleural space, minimizes risks, and enhances patient comfort during the procedure. Incorrect positioning can lead to complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
Choice A rationale
Encouraging extensive family visitation in the context of impending demise, while emotionally supportive, does not directly address the physiological mechanisms of intracranial pressure reduction. Increased stimulation and emotional distress can paradoxically elevate ICP by increasing cerebral metabolic demand and blood flow, which is counterproductive to managing an acute neurological crisis.
Choice B rationale
Maintaining the patient's neck in a midline and neutral position is crucial to facilitate optimal venous outflow from the brain. Compression or kinking of the jugular veins due to neck rotation or flexion can impede cerebral venous drainage, leading to an increase in cerebral blood volume and subsequently elevated intracranial pressure.
Choice C rationale
Administering stool softeners helps prevent straining during defecation, a maneuver known as the Valsalva maneuver. The Valsalva maneuver increases intrathoracic and intra-abdominal pressure, which in turn transiently increases central venous pressure and impedes cerebral venous outflow, thereby elevating intracranial pressure.
Choice D rationale
Keeping room curtains open to maximize natural light can increase environmental stimulation, potentially leading to increased cerebral activity and metabolic demand. This heightened activity can result in increased cerebral blood flow and volume, which can contribute to elevated intracranial pressure in a neurologically compromised patient.
Choice E rationale
Elevating the head of the bed (HOB) to 30 degrees promotes venous drainage from the brain by utilizing gravity. This position helps to reduce cerebral blood volume, thereby decreasing intracranial pressure. It also aids in preventing aspiration while maintaining cerebral perfusion pressure.
Correct Answer is B
Explanation
Choice A rationale
The presence of bacteria in the cerebrospinal fluid is a hallmark indicator of bacterial meningitis. Therefore, an absence of bacteria would typically rule out a bacterial infection, suggesting either a different etiology or a sterile CSF culture due to prior antibiotic administration.
Choice B rationale
In bacterial meningitis, bacteria consume glucose from the CSF for their metabolic needs. This leads to a characteristic decrease in CSF glucose levels (normal range 40-70 mg/dL or approximately 2/3 of blood glucose). This metabolic activity of the bacteria is a key diagnostic marker.
Choice C rationale
Bacterial meningitis is characterized by a significant inflammatory response within the central nervous system. This response includes a robust influx of leukocytes, predominantly neutrophils, into the cerebrospinal fluid. Therefore, an absence of leukocytes would contradict a diagnosis of bacterial meningitis.
Choice D rationale
The inflammation and increased permeability of the blood-brain barrier associated with bacterial meningitis often lead to an elevated protein concentration in the cerebrospinal fluid (normal range 15-45 mg/dL). Therefore, an absence of protein would be inconsistent with the expected findings.
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