Severe coughing and shortness of breath during a thoracentesis ...

[oliviahorn72]

Severe coughing and shortness of breath during a thoracentesis are indicative of which of the following complications?
 
  a. Re-expansion pulmonary edema
  b. Pleural infection
  c. Pneumothorax
  d. Hemothorax

Question 2

A nurse is obtaining the history of a patient who reveals that he had an MI 5 years ago. When the admission 12-lead ECG is reviewed, Q waves are noted in leads V3 and V4 only. Which of the following conclusions is most consistent with this situation?
 
  a. The patient may have had a posterior wall MI.
  b. The patient must have had a right ventricular MI.
  c. The admission 12-lead ECG was done incorrectly.
  d. The patient may have had an anterior MI.

[juiceman1987]

Answer to Question 1

A
Re-expansion pulmonary edema can occur when a large amount of effusion fluid (10001500 mL) is removed from the pleural space. Removal of the fluid increases the negative intrapleural pressure, which can lead to edema when the lung does not re-expand to fill the space. The patient experiences severe coughing and shortness of breath. The onset of these symptoms is an indication to discontinue the thoracentesis.

Answer to Question 2

D
Not every acute myocardial infarction (MI) results in a pathologic Q wave on the 12-lead electrocardiogram (ECG). When the typical ECG changes are not present, the diagnosis depends on symptomatic clinical presentation, specific cardiac biomarkers (e.g., cTnI, cTnT, CK-MB), and non-ECG diagnostic tests such as cardiac catheterization. Anterior and posterior wall MIs have ST changes, not Q wave changes.

[oliviahorn72]

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