The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?

Correct Answer: D

Rationale: The correct answer is D) Sitting upright with the arms supported on an over-bed table. For a thoracentesis procedure in a patient with a left-sided pleural effusion, positioning the patient sitting upright allows for better access to the pleural space and easier visualization for the healthcare provider performing the procedure. This position helps maximize lung expansion, making it easier to access the pleural effusion. Option A) High-Fowler's position with the left arm extended is incorrect as it does not provide optimal positioning for accessing the pleural effusion on the left side. Option B) Supine with the head of the bed elevated 30 degrees is incorrect because lying flat does not facilitate access to the pleural space. Option C) On the right side with the left arm extended above the head is incorrect as it does not provide the best positioning for accessing the pleural effusion on the left side and may cause discomfort to the patient. In an educational context, understanding the correct positioning for thoracentesis is crucial for providing safe and effective patient care. Proper positioning can impact the success and safety of the procedure, so nurses must be knowledgeable about the rationale behind positioning choices for various patient conditions.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Test the drainage for glucose. The priority action for a patient presenting with nasal trauma and clear drainage is to assess for the presence of cerebrospinal fluid (CSF) leakage, which can occur due to trauma to the skull base. Testing the drainage for glucose can help differentiate between CSF leakage (which would contain glucose) and nasal mucus or other fluids. Identifying CSF leakage is crucial as it can lead to serious complications such as meningitis if left untreated. Option A) Apply an ice pack to reduce swelling is incorrect because while it may help with swelling, it is not the priority when assessing for a potentially serious condition like CSF leakage. Option C) Insert nasal packing to control bleeding is also incorrect because the priority is to first determine if the clear drainage is CSF, as nasal packing could increase intracranial pressure if CSF is present. Option D) Keep the patient in a supine position is incorrect as it does not address the immediate need to assess for CSF leakage. In an educational context, this question highlights the importance of clinical assessment and critical thinking in nursing practice. Nurses must be able to prioritize actions based on the patient's condition and the potential for serious complications. Understanding the significance of assessing for CSF leakage in cases of nasal trauma is crucial for providing safe and effective care to patients.

Correct Answer: A

Rationale: The correct answer is option A: "I will blow into the meter as hard and fast as possible." This statement indicates effective learning because using a peak flow meter requires the patient to forcefully exhale to get an accurate reading of their peak expiratory flow rate, which is crucial in monitoring asthma symptoms and determining the effectiveness of treatment. Option B is incorrect because inhaling deeply before exhaling into the peak flow meter can affect the accuracy of the reading. The patient should exhale normally and forcefully to obtain the correct measurement. Option C is incorrect because peak flow meters are used for regular monitoring of asthma symptoms, not just when the patient feels short of breath. Regular use helps in identifying early signs of worsening asthma and adjusting treatment accordingly. Option D is incorrect because holding the breath after using the peak flow meter is not necessary and does not contribute to obtaining an accurate reading. It is important for the patient to exhale forcefully into the meter and then record the value without holding their breath. In an educational context, it is vital for patients with asthma to understand how to correctly use a peak flow meter to monitor their lung function. By providing clear instructions and ensuring that patients demonstrate the correct technique, nurses can empower patients to actively manage their asthma and seek timely medical intervention when necessary.

Correct Answer: B

Rationale: The most appropriate intervention for a patient with a tracheostomy experiencing thick respiratory secretions is to suction the tracheostomy as needed using sterile technique (Option B). This is because suctioning helps remove the secretions that can obstruct the airway and impede effective breathing. It is a standard nursing intervention for maintaining airway patency in patients with tracheostomies. Option A, encouraging the patient to drink more fluids, may not effectively address the immediate issue of thick secretions in the airway. While hydration is important for overall respiratory health, it may not provide immediate relief. Option C, instilling sterile saline into the tracheostomy to thin secretions, can potentially introduce infection risk and is not a recommended practice unless specifically ordered by a healthcare provider. Option D, administering a mucolytic agent prescribed by the healthcare provider, may be appropriate in some cases, but as an immediate intervention, suctioning is more effective in clearing the airway promptly. In an educational context, understanding the rationale behind each option enhances critical thinking skills and clinical reasoning in nursing practice. It is crucial for nurses to prioritize interventions based on the patient's immediate needs and evidence-based practices to ensure optimal patient outcomes.

Correct Answer: C

Rationale: In this scenario, the nurse's priority action should be to apply oxygen therapy (Option C) for the patient suspected of having a pulmonary embolism (PE). Oxygen therapy is crucial in the management of PE because it helps improve oxygenation and prevent hypoxia, which can be life-threatening in this condition. Administering anticoagulant therapy (Option A) is an important intervention for PE, but oxygen therapy takes precedence as it addresses the immediate need for oxygenation. Notifying the healthcare provider (Option B) is also important, but it is not the priority over ensuring the patient has adequate oxygen supply. Elevating the patient's legs (Option D) is not indicated in the management of PE and would not address the immediate need for oxygenation in this situation. Educationally, understanding the priority actions in managing a patient with a suspected PE is crucial for nurses to provide safe and effective care. Prioritizing interventions based on the patient's condition and immediate needs is a fundamental aspect of nursing practice.