A client with a large pleural effusion undergoes a thoracentesis. Following the procedure, which observation warrants immediate intervention by the nurse?

Reference Range:

Arterial Blood Gas (ABG) pH [7.35 to 7.45]

PaCO, [35 to 45 mm Hg]

HCO 21 to 28 mEq/L (21 to 28 mmol/L)]

PaO2 [80 to 100 mm Hg]

The client's chest x-ray Indicates decreased pleural effusion.

The client's arterial blood gas result is a pH 7.35, PaCO, 35 mm Hg, HCO,-26 mEq (26 mmol/L), PaO, 85 mm Hg.

The client has asymmetrical chest wall expansion.

The client reports pain at the insertion site.

Answer and Explanation

The Correct Answer is C

A.   A decreased pleural effusion on a chest x-ray is generally a positive outcome following a thoracentesis. It indicates that the procedure was successful in removing the excess fluid. This finding does not warrant immediate intervention and is expected after the procedure.
B.   The pH of 7.35 indicates acidosis (normal range is 7.35 to 7.45). The PaCO₂ is on the lower end of normal, suggesting that if there is an acid-base imbalance, it might be metabolic or mixed. The HCO₃⁻ is within normal limits, indicating no metabolic component. The PaO₂ is slightly below the normal range (80-100 mm Hg), which could be a concern but is not critically low.
C.   Asymmetrical chest wall expansion can indicate a complication such as pneumothorax (air in the pleural space), which could occur as a complication of thoracentesis. This finding warrants immediate intervention because it may signify a serious issue that requires prompt attention, such as the need for a chest tube or further evaluation.
D.   Pain at the insertion site is expected following a thoracentesis and is generally not an urgent concern unless it is severe or associated with other symptoms like fever, difficulty breathing, or signs of infection. This type of pain is usually managed with analgesics and does not typically require immediate intervention unless accompanied by more serious symptoms.

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Correct Answer is B

Explanation

A. While oxygen saturation is important, it's not the priority in this situation. The client's symptoms strongly suggest hypoglycemia.
B. The client's symptoms of diaphoresis, rapid heartbeat, and shakiness are classic signs of hypoglycemia. Therefore, the first action should be to confirm this diagnosis by checking the blood glucose level.
C. Administering glucose before confirming hypoglycemia can be dangerous. If the client is hyperglycemic, giving them sugar will worsen their condition.
D. Providing food without confirming hypoglycemia is not appropriate.

A. Pneumonia B. Lung cancer C. Flu D. Chronic obstructive pulmonary disease (COPD) E. Chronic bronchitis

Correct Answer is ["B","E"]

Explanation

A. Pneumonia is an acute infection that causes inflammation in the lungs. While it can lead to significant respiratory symptoms and changes, it is not typically associated with clubbed nails. Clubbing usually develops over a longer period and is more common in chronic conditions.
B. Clubbing of the nails is often associated with lung cancer, particularly with bronchogenic carcinoma. The exact mechanism is not entirely clear, but it may relate to the presence of a malignancy causing systemic changes or the release of growth factors that affect nail tissue.
C. The flu is a viral respiratory infection that is usually acute and self-limiting. Clubbed nails are not a common manifestation of influenza. Clubbing is more associated with chronic respiratory and systemic conditions rather than acute viral infections.
D. COPD, which includes emphysema and chronic bronchitis, is not commonly associated with clubbing.

E. Chronic bronchitis, a type of COPD characterized by persistent cough and sputum production, may lead to clubbed nails in some cases. The chronic hypoxemia and long-term inflammation can contribute to this nail change, although it is less commonly seen than with other conditions.

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A client with a large pleural effusion undergoes a thoracentesis. Following the procedure, which observation warrants immediate intervention by the nurse? Reference Range: Arterial Blood Gas (ABG) pH [7.35 to 7.45] PaCO, [35 to 45 mm Hg] HCO 21 to 28 mEq/L (21 to 28 mmol/L)] PaO2 [80 to 100 mm Hg]

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A client with type 2 diabetes mellitus (DM) is admitted to the hospital for uncontrolled DM. Insulin therapy is initiated with an initial dose Isophane suspension insulin at 0800. At 1600, the client reports having diaphoresis, rapid heartbeat, and feeling shaky. Which should the nurse do first?

Correct Answer is B

Explanation

Exhibits The nurse reviews client data. Select the 2 possible conditions that could have the clinical manifestation of clubbed nails for this client.

Correct Answer is ["B","E"]

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