A nurse on a telemetry unit is assessing a client who is receiving continuous cardiac monitoring. The client's heart rate is 69/min and the PR interval is 0.24 seconds. The nurse should interpret this finding as which of the following cardiac rhythms?

The correct answer is choice A. Instruct the client to avoid coughing during the procedure.

A thoracentesis is a procedure that involves inserting a needle into the pleural space to remove excess fluid or air. Coughing can increase the risk of pneumothorax (collapsed lung) or bleeding during the procedure.

Choice B is wrong because the client does not need to be NPO (nothing by mouth) for 6 hr prior to the procedure. There is no risk of aspiration during a thoracentesis.

Choice C is wrong because the client should be positioned on the unaffected side for 4 hr following the procedure. This allows the affected lung to re-expand and prevents fluid from accumulating in the pleural space again.

Choice D is wrong because the client should not be placed in the prone position during the procedure. The prone position makes it difficult to access the pleural space and can compromise breathing.

Choice A rationale: Testing skin turgor on the abdomen is common in infants and young children, but in older adults, abdominal skin often loses elasticity due to aging, making it an unreliable site for assessment.

Choice B rationale: The skin over the sternum or the subclavicular area (shoulder/chest) is the most reliable site for older adults. These areas typically maintain more elastic tissue, providing a more accurate reflection of hydration.

Choice C rationale: Assessing the stomach is essentially the same as the abdomen. This site is prone to skin sagging and loss of subcutaneous fat in elderly patients, which can lead to false-positive signs of dehydration.

Choice D rationale: The skin on the neck is thin and highly susceptible to wrinkles and sun damage. Lifting the skin here in an older adult will often show "tenting" even if the patient is well-hydrated.