# Place the nursing actions in order when a client develops acute dyspnea and unilateral absent breath sounds immediately after therapeutic thoracentesis.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396386&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

Place the nursing actions in order when a client develops acute dyspnea and unilateral absent breath sounds immediately after therapeutic thoracentesis.

Position for ventilation as tolerated, administer prescribed emergency oxygen to the target saturation, and continue continuous cardiorespiratory monitoring

Reassess respiratory status and hemodynamics frequently, inspect the procedure site, document the event and response, and complete handoff

Notify the procedural or rapid-response clinician urgently and facilitate immediate bedside evaluation and chest imaging without leaving the client unattended

Prepare for prescribed pleural decompression or chest-drain treatment if imaging and clinical findings confirm a large, progressive, or symptomatic pneumothorax

Stop any aspiration or drainage, remain with the client, call for immediate assistance, and rapidly assess airway, breathing, circulation, vital signs, oxygenation, and bilateral breath sounds

## Explanation

Stop the pleural procedure and assess the client immediately when worsening breathlessness develops. Support oxygenation and monitor continuously, then mobilize urgent expert evaluation and imaging for pneumothorax, hemorrhage, or re-expansion pulmonary edema. A large, progressive, or symptomatic post-thoracentesis pneumothorax may require pleural decompression or a chest drain. Continue reassessment because hypotension, tracheal deviation, or rapidly worsening distress can signal tension physiology requiring immediate emergency treatment without waiting for routine imaging.

## In-depth explanation

Correct sequence
Stop and assess → support oxygenation → urgent clinician and imaging → prepare definitive pleural treatment → reassess and document.

Why this is correct
Pneumothorax is the most common complication of pleural aspiration. New hypoxemia, dyspnea, chest pain, or unilateral breath-sound loss after the procedure requires prompt evaluation. Deterioration with tension physiology is an emergency and should not wait for routine imaging.

NCLEX decision rule
For a procedure complication, stop the precipitating action, stabilize airway and breathing, escalate, and prepare cause-directed treatment.References
1British Thoracic Society Clinical Statement on Pleural Procedures
2NCBI: Thoracentesis

## Clinical scenario

Post-thoracentesis respiratory complication
The client is awake, oxygen saturation is 82% on room air, blood pressure is 124/72 mm Hg, and the procedure catheter is still connected but no longer draining. Treat this as a symptomatic pleural complication while the cause is confirmed.

## Key concepts

- **Iatrogenic Pneumothorax** — Air in the pleural space caused by a medical procedure, potentially leading to partial or complete lung collapse.
- **Tension Physiology** — Progressive intrapleural pressure that impairs ventilation and venous return and requires immediate decompression.
- **Thoracentesis** — Needle or catheter aspiration of pleural air or fluid for diagnosis or symptom relief.

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