The nurse is preparing a patient with pleural effusion for thoracentesis. Which is the most appropriate position for the procedure?

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Instruct the patient to elevate the foot. Elevating the foot helps reduce swelling, improve circulation, and promote wound healing in patients with foot ulcers. By elevating the foot, the pressure on the ulcer is reduced, which can prevent further damage and aid in the healing process. Encouraging the patient to wear shoes (A) may be important for protection, but it is not the priority over immediate wound care. Performing a sterile dressing change (C) and applying antibiotic ointment (D) are important interventions, but they should be done after elevating the foot to address the underlying issue of poor circulation and pressure on the ulcer.

Correct Answer: B

Rationale: The correct answer is B: Administer nitroglycerin. Nitroglycerin is the priority intervention because chest pain in a patient with a history of hypertension could indicate angina or a possible myocardial infarction. Nitroglycerin helps dilate blood vessels, reduce workload on the heart, and improve blood flow to the heart muscle, which can alleviate chest pain. Administering aspirin can also be beneficial to prevent clot formation, but nitroglycerin takes precedence in this situation. Providing reassurance and support is important but should not delay immediate treatment. Administering IV fluids is not indicated for chest pain in this scenario.

Correct Answer: C

Rationale: The most appropriate nursing diagnosis is "Ineffective coping related to unknown outcome of illness" (Choice C). This is because the patient's expression of feeling like a burden and wishing to be dead indicates difficulty coping with the uncertainties and challenges of their COPD. The patient's emotional distress and sense of hopelessness suggest ineffective coping mechanisms in dealing with their illness. Choice A (Complicated grieving) is incorrect because the patient's statement does not indicate grief over an actual loss, but rather a sense of burden and hopelessness. Choice B (Chronic low self-esteem) is incorrect as the patient's statement is more related to the impact of the illness on others rather than self-esteem issues. Choice D (Deficient knowledge) is not the most appropriate as the patient's statement reflects emotional distress rather than a lack of knowledge about COPD.