A nurse is caring for a client who is scheduled to undergo a thoracentesis. Which intervention should the nurse complete prior to the procedure?

Correct Answer: D

Rationale: The correct answer is D: Validate that informed consent has been given by the client. This is crucial before any invasive procedure to ensure the client fully understands the risks, benefits, and alternatives. This protects the client's autonomy and promotes ethical practice. Choice A is incorrect because measuring oxygen saturation before and after a 12-minute walk is not relevant to preparing for a thoracentesis. Choice B is incorrect because while it is important for the client to understand possible complications, verifying this understanding is not the priority before the procedure. Choice C is incorrect because explaining the procedure in detail to the client and family is important, but ensuring informed consent comes first to respect the client's autonomy.

Correct Answer: C

Rationale: Rationale for Correct Answer (C: Rifampicin): 1. Rifampicin is a first-line antibiotic for TB treatment. 2. It works by inhibiting RNA synthesis in the TB bacteria. 3. TB bacteria are less likely to develop resistance to Rifampicin. 4. Its effectiveness in treating TB has been well-documented. Summary of Why Other Choices Are Incorrect: A: Ethambutol - Effective against TB but not the most commonly used drug like Rifampicin. B: Streptomycin - Can be used in TB treatment but not as effective as Rifampicin. D: Penicillin - Ineffective against TB as TB bacteria are resistant to Penicillin.

Correct Answer: A

Rationale: The correct answer is A: The patient has a narrowed airway. Wheezing throughout the lung fields indicates the presence of narrowed airways, often due to conditions like asthma or chronic obstructive pulmonary disease (COPD). Wheezing is caused by turbulent airflow through narrowed airways, leading to a high-pitched whistling sound during expiration. This is a characteristic finding in patients with obstructive airway diseases. Summary of other choices: B: The patient having pneumonia would typically present with symptoms like fever, cough, and consolidation on auscultation, not wheezing. C: The patient needing physiotherapy may have respiratory muscle weakness or secretion clearance issues but would not typically present with wheezing throughout lung fields. D: The presence of a hemothorax (blood in the pleural space) would manifest as decreased breath sounds and signs of respiratory distress but not wheezing.

Correct Answer: B

Rationale: The correct answer is B: Maintaining the patient's chest tube. After a mediastinotomy, the focus of postprocedure care is to ensure proper drainage and prevent pneumothorax. Chest tube maintenance is crucial for monitoring drainage, preventing complications, and promoting lung expansion. Assisting with PFT (A) is not a priority immediately post mediastinotomy. Administering oral suction (C) can disrupt the chest tube and increase infection risk. Performing chest physiotherapy (D) may be indicated later but is not the immediate priority.

Correct Answer: B

Rationale: The correct answer is B: epiglottis. The epiglottis is a flap of tissue that covers the opening of the trachea during swallowing, preventing food and fluid from entering the lower respiratory system. This mechanism ensures that the airway remains clear and protects the lungs from aspiration. The other choices are incorrect because: A: The larynx is involved in sound production and air passage but does not specifically protect the lower respiratory system during swallowing. C: The vestibule is the space within the nasal cavity but does not play a direct role in protecting the lower respiratory system during swallowing. D: The pharynx is a passageway for both food and air but does not specifically prevent food and fluid bolus from entering the lower respiratory system during swallowing.