A nurse is collecting data from a patient following a thoracentesis.
Which of the following findings should prompt the nurse to notify the provider?
500 mL of fluid removed during thoracentesis.
Chest x-ray clear.
PCO2.
Hematocrit.
The Correct Answer is A
Choice A rationale
If 500 mL of fluid is removed during thoracentesis, the nurse should notify the provider. Removing large volumes of fluid can cause re-expansion pulmonary edema.
Choice B rationale
A clear chest x-ray is an expected finding after thoracentesis.
Choice C rationale
PCO2 is a measure of carbon dioxide levels in the blood. It is not directly related to thoracentesis.
Choice D rationale
Hematocrit is a measure of the proportion of red blood cells in the blood. It is not directly related to thoracentesis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
For a client with COPD who reports shortness of breath and little appetite, limiting fluid intake during meals can help to prevent early satiety and promote better food intake. Fluids can make the client feel full quickly, which can limit their intake of necessary nutrients.
Choice B rationale
Consuming three regular meals daily may not be the best approach for a client with COPD who has little appetite. Smaller, more frequent meals may be easier for the client to tolerate.
Choice C rationale
Eating lighter, low-calorie foods first is not the best advice for a client with COPD who has little appetite. The client may need high-calorie, nutrient-dense foods to meet their nutritional needs.
Choice D rationale
Eliminating dairy products is not generally recommended for clients with COPD unless they have a specific intolerance. Dairy products can be a good source of protein and other nutrients.
Correct Answer is A
Explanation
Comparing the current blood pressure reading to the preoperative value is the first step the nurse should take. This will help determine if the patient’s blood pressure has significantly dropped, which could indicate hypovolemia or shock.
Choice B rationale
Covering the patient with a warm blanket may be helpful if the patient is feeling cold or showing signs of hypothermia, but it would not address the underlying cause of the low blood pressure.
Choice C rationale
Increasing the IV flow rate might be necessary if the patient is hypovolemic, but this decision should be based on additional assessment data and physician orders.
Choice D rationale
Reassuring the patient is important, but it should not be the first action. The nurse needs to assess and address the cause of the low blood pressure.
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