A nurse is monitoring a client who has just had a thoracentesis to remove pleural fluid. Which of the following clinical manifestations should indicate to the nurse the client is experiencing a complication and the provider should be notified immediately?

Serosanguineous drainage from the puncture site

Discomfort at the puncture site

Increased heart rate

Decreased temperature

Answer and Explanation

The Correct Answer is C

Choice A reason: Serosanguineous drainage from the puncture site is an expected finding after a thoracentesis and does not typically indicate a complication.

Choice B reason: Discomfort at the puncture site is common following a thoracentesis and does not necessarily indicate a complication.

Choice C reason: The correct answer is c because an increased heart rate can be a sign of respiratory distress or hypovolemia, which are potential complications of a thoracentesis. This finding warrants immediate notification of the provider.

Choice D reason: A decreased temperature is not a common complication of thoracentesis and is less relevant than the other options. It is more important to monitor for signs of respiratory distress or circulatory changes.

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Correct Answer is C

Explanation

Choice A reason: While early CPR is crucial, the AED should be attached as soon as it is available to analyze the heart rhythm and provide a shock if needed. Delaying the use of the AED can reduce the chances of successful resuscitation.

Choice B reason: In adults, the carotid pulse is typically checked, not the brachial pulse. The brachial pulse is more commonly assessed in infants.

Choice C reason: The correct answer is c because providing chest compressions at a rate of 100-120 compressions per minute is the recommended rate for effective CPR. High-quality chest compressions are essential for maintaining circulation during cardiac arrest.

Choice D reason: The recommended ratio of chest compressions to rescue breaths is 30:2, not 50:2. Performing 50 compressions before providing rescue breaths is not aligned with current CPR guidelines.

A. Orange juice B. Watermelon C. Bananas D. Corn flakes cereal E. White rice

Correct Answer is ["A","B","C"]

Explanation

Choice A reason: The correct answer is a because orange juice is high in potassium and should be avoided by clients with chronic kidney disease to prevent hyperkalemia, which can lead to serious cardiac complications.

Choice B reason: The correct answer is b because watermelon, although refreshing, is high in potassium and should be limited or avoided by clients with chronic kidney disease to maintain safe potassium levels.

Choice C reason: The correct answer is c because bananas are well-known for their high potassium content and should be avoided by clients with chronic kidney disease to prevent elevated potassium levels in the blood.

Choice D reason: Corn flakes cereal is generally low in potassium and is not a food that needs to be avoided in clients with chronic kidney disease. It can be included in their diet in moderation.

Choice E reason: White rice is also low in potassium and can be safely consumed by clients with chronic kidney disease. It does not pose a significant risk of increasing potassium levels.

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A nurse is monitoring a client who has just had a thoracentesis to remove pleural fluid. Which of the following clinical manifestations should indicate to the nurse the client is experiencing a complication and the provider should be notified immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is ["A","B","C"]

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