A nurse is caring for a client with pleural effusion who is scheduled for thoracentesis. Which nursing intervention is the priority before the procedure?

Obtaining informed consent is the priority before any invasive procedure like thoracentesis, as it is a legal and ethical requirement. Other interventions like pain management, positioning, or vital signs assessment are important but secondary to consent.

Clinical Judgment This problem is a priority-setting problem that combines the Recognize Cues and Generate Solutions stages. All options are nursing interventions needed before thoracentesis, but legal and ethical obligations are absolute prerequisites for proceeding with the procedure. The patient's condition (progressive dyspnea, chest pain) indicates the urgency of the procedure, but no invasive procedure can begin without proper informed consent. The nurse's role is not simply to obtain a signature, but to verify that the patient understands the purpose, risks, benefits, and alternatives of the procedure (Client Education) and to assess their decision-making capacity. Memory Tip The priority before an invasive procedure is Consent first, Care second. Remember it as "Informed Consent is the Key." KR vs US In Korea, the physician primarily explains and obtains consent, but the nurse plays a supporting role by checking the patient's understanding and asking if they have additional questions. In the US NGN/CJMM, it is standard practice for the nurse to assess the patient's decision-making capacity and confirm their understanding of the explanation, which is emphasized as part of legal responsibility. The consent process is more formal and patient-centered.

Clinical Practice Guide
Before thoracentesis, the nurse should make the following comprehensive preparations:
1. Confirm informed consent: Document the signed consent form and the patient's understanding.
2. Assess baseline status: Measure vital signs, oxygen saturation, breath sounds, and pain level to establish a comparison baseline for after the procedure.
3. Prepare positioning: Have the patient sit on the edge of the bed with arms and head supported on a support to achieve a comfortable position. This expands the thoracic cavity and assists the practitioner.
4. Provide psychological support: Explain the procedure and alleviate anxiety.
5. Prepare necessary supplies: Prepare a sterile puncture set, local anesthetic, culture tubes, etc.

Caution
- In SATA (Select All That Apply) questions, if asked about the "priority" intervention, obtaining informed consent is the single correct answer.
- If asked about interventions to perform "immediately before" the procedure, measuring baseline vital signs and changing position may be more appropriate answers. Read the question context accurately.
- Pain management (option 1) is important, but if the pain before the procedure is not severe, it is a lower priority. Monitoring pain after the procedure may be more important.