A client is scheduled for a thoracentesis that will be done at the bedside. What should the practical nurse (PN) prepare before the healthcare provider arrives on the unit to perform the procedure?
Place the client in an orthopneic position
Keep the client NPO and encourage to void.
Gather the procedure tray and equipment.
Cleanse the site and cover with a sterile towel.
The Correct Answer is C
The correct answer is Choice C:
Gather the procedure tray and equipment. Choice A rationale:
Placing the client in an orthopneic position (sitting upright and leaning forward) is not necessary for a thoracentesis procedure. The position may be uncomfortable for the client and does not facilitate the procedure.
Choice B rationale:
Keeping the client NPO (nothing by mouth) and encouraging them to void before the procedure is not directly relevant to a thoracentesis. NPO status might be indicated for other procedures requiring anesthesia but not for a bedside thoracentesis.
Choice C rationale:
This is the correct choice. The PN should prepare by gathering the procedure tray and equipment before the healthcare provider arrives to perform the thoracentesis. This ensures that all necessary items are readily available for the procedure.
Choice D rationale:
Cleansing the site and covering it with a sterile towel is a task usually performed by the healthcare provider who will be performing the thoracentesis. The PN's role is to prepare the necessary equipment and assist the provider during the procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
This is the best action for the PN to take because it provides immediate relief for the client's pain, which can be severe and debilitating in Herpes zoster. The PN should also assess the client's pain level, location, and characteristics and document the response to the medication.
B. Obtaining an oxygen tank for home administration is not indicated for this client and does not address his pain issue. Herpes zoster does not affect the respiratory system and does not cause hypoxia or dyspnea.
C. Giving the next prescribed dose of antiviral medication is not a priority for this client and may not have an immediate effect on his pain. Antiviral medication can help reduce the duration and severity of Herpes zoster, but it does not provide analgesia.
D. Notifying the nursing supervisor of uncontrolled pain is not a priority for this client and may delay his pain relief. The PN should notify the nursing supervisor only if the prescribed analgesic is ineffective or causes adverse effects.
Correct Answer is D
Explanation
The correct answer is Choice D. What are the voices uttering?
Choice A rationale:
While it is essential to assess how the client copes with auditory hallucinations, asking this question alone does not provide specific information about the content of the hallucinations. Knowing what the voices are saying is vital in understanding the nature and potential impact of the hallucinations.
Choice B rationale:
Knowing when the voices are most disturbing can provide some insights into the pattern of the auditory hallucinations. However, this information alone may not fully address the client's current experience or their response to the hallucinations.
Choice C rationale:
Inquiring about which medication works best is important, but it should come after understanding the nature of the hallucinations. Medication management is a crucial aspect of treating schizophrenia, but gathering information about the content of the hallucinations helps in formulating an appropriate treatment plan.
Choice D rationale:
The correct choice. Knowing what the voices are uttering is essential in assessing the severity and potential impact of the auditory hallucinations on the client's well-being. This information will guide the healthcare team in providing targeted interventions and support to manage the symptoms effectively.
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