The nurse is teaching a patient about home care following discharge after a thoracentesis. Which statement by the patient indicates a need for further teaching?

Correct Answer: C

Rationale: The correct answer is C because lifting anything heavier than 20 pounds can strain the area where the thoracentesis was performed, leading to complications like bleeding or pain. A: Indicates awareness of potential respiratory issues. B: Rest is essential for recovery. D: Monitoring for signs of infection at the site is crucial. It's important for the patient to understand and follow all post-procedure instructions to ensure proper healing and prevent complications.

Correct Answer: A

Rationale: The correct answer is A: Pulmonary embolism. Sudden chest pain and dyspnea are classic symptoms of a pulmonary embolism, which is a blockage in one of the pulmonary arteries. This condition requires immediate medical attention due to the risk of serious complications like pulmonary infarction. Pneumothorax (B) presents with sharp chest pain and shortness of breath but is more commonly associated with trauma or underlying lung disease. Pneumonia (C) typically presents with gradual onset of symptoms such as fever and productive cough. Asthma attack (D) presents with wheezing and coughing, usually triggered by allergens or exercise.

Correct Answer: B

Rationale: The correct answer is B: Oxygen saturation of 89%. A low oxygen saturation level of 89% indicates hypoxemia and requires immediate intervention to prevent complications like tissue damage or organ failure. Oxygen is essential for cellular function, and a saturation below 90% is concerning. Coughing with blood-tinged sputum (A) is common post-bronchoscopy. Hoarseness and sore throat (C) are expected due to the procedure. Mild chest discomfort (D) is also common post-bronchoscopy and may not require immediate intervention.

Correct Answer: C

Rationale: The correct next action is to assess the system for an air leak. This is because continuous bubbling in the water-seal chamber indicates air is escaping from the patient's chest cavity through the tube. By assessing the system for an air leak, the nurse can identify and address the source of the problem. Clamping the chest tube (choice A) can lead to a tension pneumothorax and is not appropriate. Adding more water (choice B) is incorrect as it will not address the underlying issue. Replacing the entire system (choice D) is unnecessary without first identifying the specific problem.

Correct Answer: C

Rationale: The correct answer is C: Assess the system for loose connections or dislodgment. This is the best action because identifying the cause of the air leak is crucial before taking any further steps. Clamping the chest tube (A) can lead to tension pneumothorax. Notifying the healthcare provider (B) is important but does not address the immediate need to assess the system. Increasing suction (D) can worsen the situation if the cause of the air leak is not resolved. Overall, assessing the system first ensures proper management and prevents potential complications.