Author Question: A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action? ... (Read 28 times)

saliriagwu · **on:** Jun 25, 2018

A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action?

a. The client rates pain as a 5/10 at the site of the procedure.
b. A small amount of drainage from the site is noted.
c. Pulse oximetry is 93 on 2 liters of oxygen.
d. The trachea is deviated toward the opposite side of the neck.

Question 2

A nurse is assessing a client who is recovering from a lung biopsy. Which assessment finding requires immediate action?

a. Increased temperature
b. Absent breath sounds
c. Productive cough
d. Incisional discomfort

emily12345 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: D
A deviated trachea is a manifestation of a tension pneumothorax, which is a medical emergency. The other findings are normal or near normal.

Answer to Question 2

ANS: B
Absent breath sounds may indicate that the client has a pneumothorax, a serious complication after a needle biopsy or open lung biopsy. The other manifestations are not life threatening.