The nurse is preparing a patient for thoracentesis. Which position is most appropriate?

Correct Answer: B

Rationale: The correct position for thoracentesis is sitting upright and leaning forward (Choice B). This position allows better access to the thoracic cavity, facilitating the procedure and reducing the risk of complications. Sitting upright helps expand the intercostal space, making it easier to insert the needle accurately. Leaning forward also helps the patient breathe more comfortably during the procedure. Supine position (Choice A) with the head of the bed flat may not provide optimal access to the thoracic cavity. Lying on the affected side (Choice C) may not allow proper visualization and access to the site. Prone position with arms raised above the head (Choice D) is not suitable for thoracentesis as it does not facilitate proper access to the thoracic cavity.

Correct Answer: C

Rationale: The correct answer is C because assessing oxygen saturation and lung sounds is crucial in determining the patient's respiratory status. This helps identify potential complications like pneumothorax or atelectasis, which are common after thoracotomy. Deep breaths (A) can worsen conditions like pneumothorax. Notifying the healthcare provider (B) may delay immediate action. Administering bronchodilators (D) is not appropriate without a comprehensive assessment.

Correct Answer: B

Rationale: The correct answer is B: Sitting upright and leaning forward. This position allows optimal lung expansion and better access to the pleural effusion, making the procedure safer and more effective. Conversely, A (supine) can cause difficulty in accessing the effusion, C (on the side opposite) may not provide adequate lung expansion, and D (prone) can hinder access to the effusion and increase the risk of complications.

Correct Answer: A

Rationale: The correct answer is A: Adherence to the full course of prescribed medications. This is the priority teaching point because adherence to the full course of TB medications is crucial to ensure complete eradication of the bacteria and prevent the development of drug-resistant strains. Skipping doses or stopping treatment prematurely can lead to treatment failure and the spread of TB. Choice B is incorrect because avoiding contact with family members during treatment is not necessary as TB is not spread through casual contact. Choice C is incorrect as completing follow-up skin tests every six months is not the priority teaching point, although it may be part of the follow-up care plan. Choice D is incorrect as using a surgical mask when going outdoors is not necessary unless the patient is actively coughing and symptomatic.

Correct Answer: D

Rationale: The correct answer is D: Discuss the need for an injectable antibiotic with the health care provider. If a patient continues to have positive sputum smears for AFB after 2 months of standard TB treatment, it suggests drug resistance. The next step would be to consider adding an injectable antibiotic like amikacin or streptomycin to the treatment regimen. This decision should be made in consultation with the healthcare provider based on culture and sensitivity testing results. A: Teaching about drug-resistant TB is important, but the immediate action should be to adjust the treatment regimen. B: Scheduling directly observed therapy may help with medication adherence but does not address the need for a change in treatment. C: Asking about medication adherence is important, but if the patient has been compliant, a change in treatment is necessary.