A nurse is caring for a client who reports experiencing alteration in sense of smell following surgery for a total laryngectomy. The nurse should address the client's concern through which of the following response?

Pulmonary Function Tests assess chronic respiratory conditions like COPD and asthma. In an acute pneumothorax, these tests are unnecessary as the priority is stabilizing the airway and restoring lung expansion. The client is in respiratory distress, making PFTs impractical and irrelevant at this stage.

Obtain Intravenous Access: IV access is necessary to administer fluids, medications, and potential emergency interventions. Given the client's signs of respiratory distress and hemodynamic instability (tachycardia, hypotension), IV access ensures rapid treatment in case of deterioration.

Thoracentesis: Thoracentesis is used to remove pleural fluid in conditions like pleural effusion but is not appropriate for a pneumothorax. Inserting a needle into the pleural space could worsen the lung collapse and lead to further respiratory compromise. The correct intervention is a chest tube insertion.

Obtain ABGs: ABGs provide critical information on oxygenation, ventilation, and acid-base balance. The client has tachypnea, cyanosis, and low O₂ saturation, indicating possible respiratory acidosis or hypoxemia. ABGs will guide oxygen therapy and further management.

Prepare for Insertion of a Chest Tube: A chest tube is the definitive treatment for a pneumothorax. It removes air from the pleural space, allowing lung re-expansion. Given the client's absent breath sounds, tachypnea, and hypoxia, immediate chest tube insertion is necessary to prevent further deterioration.

Computed Tomography (CT) of the Chest: While a CT scan provides detailed lung imaging, it is not the first-line diagnostic tool for pneumothorax. A chest X-ray is usually sufficient to confirm the diagnosis. In an emergency setting, immediate intervention (such as chest tube placement) takes priority over advanced imaging.

A. Client develops ecchymosis at the venipuncture site. Minor bruising at venipuncture sites is a common and expected side effect of heparin therapy due to its anticoagulant effect. While the nurse should monitor for increased bruising, isolated ecchymosis at an IV site does not necessarily indicate excessive anticoagulation or require immediate provider notification.
B. PTT 70 seconds (control 25-40). Heparin therapy is adjusted based on the activated partial thromboplastin time (aPTT). The therapeutic range is typically 1.5 to 2.5 times the control value, which in this case would be approximately 60-100 seconds. A PTT of 70 seconds is within the therapeutic range, so it does not require urgent intervention.
C. Client develops hematuria. Hematuria is a sign of potential excessive anticoagulation or internal bleeding, which can be a serious complication of heparin therapy. This finding suggests that the client's coagulation status may need immediate reassessment, and the heparin infusion may require adjustment or reversal with protamine sulfate if necessary. The healthcare provider should be notified promptly.
D. Order for Coumadin 2.5 mg to begin today. It is common practice to start warfarin (Coumadin) while a client is on heparin therapy because warfarin takes several days to reach therapeutic levels. Heparin is typically continued until the INR reaches a therapeutic range. Therefore, this order does not require provider notification.