An older adult patient arrives at the clinic reporting decreased strength in knees and handgrips. What action should the nurse include in a functional assessment of this patient?

The correct answer is Choice D.

Brief Introduction This scenario requires applying knowledge of chest tube dynamics and respiratory physiology during patient positioning. Sudden dyspnea in a patient with a hemopneumothorax indicates a potential obstruction in the drainage system, necessitating immediate troubleshooting of the tubing to ensure lung re-expansion and prevent tension pneumothorax or fluid accumulation.

Choice A rationale: Reinforcing the connection with tape is a preventive measure to maintain system integrity. However, it does not address the immediate cause of sudden acute respiratory distress following a position change, which is more likely related to a mechanical obstruction in the tubing rather than a connection failure.

Choice B rationale: Clamping a chest tube is generally contraindicated as it can rapidly lead to a tension pneumothorax by preventing the escape of air and fluid from the pleural space. This action would likely worsen the patient's anxiety and shortness of breath by increasing intrapleural pressure.

Choice C rationale: An occlusive dressing is only applied if the chest tube is accidentally dislodged from the insertion site. Since the scenario implies the tube is still in place but the patient became symptomatic during a turn, applying a dressing over an intact tube is an incorrect intervention.

Choice D rationale: Turning a patient can cause the chest tubing to kink or create dependent loops that trap fluid. This obstruction prevents the drainage of air and blood, leading to sudden respiratory distress. Ensuring the tubing is patent and straight is the immediate priority to restore proper pleural suction.

Choice A rationale
Administering the medication at 1000, 1600, 2200, and 0400 would not be the best schedule because it does not evenly distribute the doses throughout the day. This could lead to periods of subtherapeutic medication levels and periods of potential toxicity.
Choice B rationale
Administering the medication with meals and a bedtime snack is not the best schedule for this medication. While some medications need to be administered with food, there is no indication

that this medication needs to be. Furthermore, this schedule could lead to uneven distribution of the medication throughout the day.
Choice C rationale
Giving the medication in equally divided doses during waking hours is not the best schedule because it does not take into account the half-life of the medication or the patient’s sleep schedule. This could lead to subtherapeutic levels of the medication during the night.
Choice D rationale
Administering the medication at 0800, 1200, 1600, and 2000 is the best schedule for this medication. It evenly distributes the doses throughout the day, which can help maintain a therapeutic level of the medication and reduce the risk of toxicity.