the nurse prepares a patient with a left sided pleural effusion for a thoracentesis how should the nurse position the patient

NCLEX-RN

NCLEX RN Prioritization Questions

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

A. Supine with the head of the bed elevated 30 degrees
B. In a high-Fowler's position with the left arm extended
C. On the right side with the left arm extended above the head
D. Sitting upright with the arms supported on an overbed table

Correct answer: D

Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.

2. A patient has been diagnosed with acute gastritis in a clinic. Which of the following medications would be contraindicated for this patient?

A. Naproxen sodium (Naprosyn)
B. Calcium carbonate
C. Clarithromycin (Biaxin)
D. Furosemide (Lasix)

Correct answer: A

Rationale: Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Gastritis involves inflammation of the stomach lining, and medications like Naproxen can exacerbate this condition. Calcium carbonate is an antacid that can help neutralize stomach acid and may actually provide relief for gastritis symptoms. Clarithromycin is an antibiotic used to treat H. pylori infection, a common cause of gastritis. Furosemide is a loop diuretic used to treat conditions like edema and hypertension, not directly contraindicated in gastritis.

3. A patient diagnosed with alopecia would be described as having:

A. body lice
B. lack of ear lobes
C. Indigestion
D. hair loss

Correct answer: D

Rationale: The correct answer is 'hair loss.' Alopecia is a medical term that specifically refers to the condition of hair loss, usually in patches or all over the body. Choice A, 'body lice,' refers to a parasitic infestation and is not related to alopecia. Choice B, 'lack of ear lobes,' is completely unrelated to the term alopecia, which is solely about hair loss. Choice C, 'Indigestion,' has no connection to alopecia as it pertains to digestive issues, not hair loss. Therefore, the correct description for a patient diagnosed with alopecia is 'hair loss.'

4. What is the likely cause of pericarditis in a young patient?

A. Heart failure
B. Acute MI
C. Hypertension
D. Infectious processes

Correct answer: D

Rationale: In younger patients, pericarditis is typically caused by an infection commonly triggered by viruses like the Coxsackie virus, streptococcus, staphylococcus, or Haemophilus influenzae. Infectious processes are the leading cause of pericarditis in younger individuals. Heart failure, Acute MI, and Hypertension are not common causes of pericarditis in young patients. In older adults, acute myocardial infarction (MI) is a more common cause of pericarditis.

5. A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment?

A. Paradoxic chest movement
B. Complaint of chest wall pain
C. Heart rate of 110 beats/minute
D. Large bruised area on the chest

Correct answer: A

Rationale: Paradoxic chest movement is the most concerning finding as it indicates a potential flail chest, which can lead to severe compromise in gas exchange and rapid hypoxemia. This condition requires immediate attention to prevent respiratory distress. Complaint of chest wall pain, a slightly elevated heart rate, and a large bruised area on the chest are important assessment findings but may not immediately threaten gas exchange or respiratory function. Therefore, identifying paradoxic chest movement is critical for prompt intervention and management.