71. In assisting a physician to perform a thoracentesis, how should the nurse position a client with pleural effusion of the left lung?
71. In assisting a physician to perform a thoracentesis, how should the nurse position a client with pleural effusion of the left lung?
. Supine with the left arm extended over the head.
. Sitting at the side of the bed with both arms resting on a locked over-the-bed table.
. High Fowler's position with both arms resting on pillows.
. Semi-Fowler's position tilted on the right side.
Test-Taking Tip
First visualize the positions. Recall that gravity promotes maximal drainage of pleural fluid. Choose the position that will promote the best access and aspiration of pleural fluid (Answer 2); Answer 3 impedes accessibility, and Answers 1 and 4 impede maximal drainage.
Content Area: Adult Health, Respiratory; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Therapeutic Procedures
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Answer 1 is incorrect because, although this position will promote separation of the ribs, it will not promote maximal access to the fluid. Answer 2 is correct because having the client's pleural cavity in a good vertical, yet safe, comfortable position will achieve maximum access to the pleural fluid. The fluid will gravitate to the lowest point for maximal aspiration. Answer 3 is incorrect because there is inadequate exposure for a midaxillary or posterior aspiration of the pleural fluid. It would be the proper position for the insertion of a chest tube for the aspiration of air, as in a pneumothorax. Answer 4 is incorrect because this position will not facilitate maximal drainage.