An Hour After a Thoracotomy,a Patient Complains of Incisional Pain

question 48

Multiple Choice

An hour after a thoracotomy,a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds.The pleural drainage system has 100 mL of bloody drainage and a large air leak.Which action is best for the nurse to take next?

• A) Milk the chest tube gently to remove any clots.
• B) Clamp the chest tube momentarily to check for the origin of the air leak.
• C) Assist the patient to deep breathe, cough, and use the incentive spirometer.
• D) Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

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