The nurse completes discharge teaching for a patient who has had ...

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The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement?
 
  a. I will make an appointment to see the doctor every year.
  b. I will stop taking the prednisone if I experience a dry cough.
  c. I will not worry if I feel a little short of breath with exercise.
  d. I will call the health care provider right away if I develop a fever.

Question 2

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure?
 
  a. Start a peripheral IV line to administer the necessary sedative drugs.
  b. Position the patient sitting upright on the edge of the bed and leaning forward.
  c. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time.
  d. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

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Answer to Question 1

ANS: D
Low-grade fever may indicate infection or acute rejection so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team. Annual health care provider visits would not be sufficient. Home oxygen use is not an expectation after lung transplant. Shortness of breath should be reported. Low-grade fever, fatigue, dyspnea, dry cough, and oxygen desaturation are signs of rejection. Immunosuppressive therapy, including prednisone, needs to be continued to prevent rejection.

Answer to Question 2

ANS: B
When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed. The patient does not usually require sedation for the procedure, and there are no restrictions on oral intake because the patient is not sedated or unconscious. Usually only 1000 to 1200 mL of pleural fluid is removed at one time. Rapid removal of a large volume can result in hypotension, hypoxemia, or pulmonary edema.

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