A patient with pleural effusion develops respiratory distress after thoracentesis. On examination, on one side of the lung there is absent lung sound with hyper ventilation. What is the most likely complication?

1. A

   Pneumonia

2. B

   Pneumothorax

3. C

   Pleural effusion

4. D

   Atelectasis

Appeared in: NORCET 10 Prelims-2026

Explanation

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• Pneumothorax is a well-known iatrogenic complication of thoracentesis, where the needle punctures the visceral pleura.
• The classic signs presented by the patient—acute respiratory distress and absent breath sounds on the affected side—are hallmark features of a collapsed lung due to pneumothorax.
• The accumulation of air in the pleural space prevents the lung from expanding, leading to the absence of air movement and thus no breath sounds.
• While the question mentions 'hyperventilation' (rapid breathing), the key diagnostic sign on percussion for pneumothorax is hyperresonance, caused by the trapped air.

Why Other Options Were Wrong

• Option A: Pneumonia is an infection of the lung tissue. It typically presents with fever, productive cough, and crackles or bronchial breath sounds, not absent sounds and hyperresonance. It is also less likely to have such an abrupt onset immediately after a procedure.
• Option C: Pleural effusion is the condition the patient was being treated for. While it causes decreased breath sounds, the percussion note would be dull due to fluid, not hyperresonant from air. A rapid re-accumulation of fluid could cause distress but would not explain the specific combination of signs.
• Option D: Atelectasis is the collapse of alveoli. While it can occur post-procedure and cause decreased breath sounds, it is characterized by a dull percussion note and may cause the trachea to shift toward the affected side, not away from it.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Complications of Thoracentesis in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses play a critical role in monitoring patients after invasive procedures like thoracentesis. Prompt recognition of complications like pneumothorax is essential for patient safety.
• The primary nursing action upon suspecting a pneumothorax is to assess the patient, ensure a patent airway, apply oxygen, and notify the physician immediately for intervention.
• What if? If the patient's signs included a tracheal shift away from the affected side, hypotension, and tachycardia, the nurse should suspect a tension pneumothorax, a life-threatening emergency requiring immediate needle decompression.

How to Approach the Question

• First, identify the core clinical scenario: a patient develops sudden distress after a specific procedure (thoracentesis).
• Analyze the key signs and symptoms provided: respiratory distress and absent lung sounds on one side.
• Recall the common complications associated with thoracentesis. Puncturing the lung (pneumothorax) is a primary risk.
• Evaluate each option based on the clinical findings. Ask yourself, 'Which condition matches the triad of thoracentesis, sudden respiratory distress, and absent breath sounds?'
• Pneumothorax is the only option that perfectly fits the acute onset and physical exam findings post-procedure.
• Differentiate from other options by considering their typical percussion notes (dull vs. hyperresonant) and other associated symptoms (e.g., fever in pneumonia).

Concept Tested & Keywords

• Concept Tested: Complications of Thoracentesis
• Stem keywords: pleural effusion, thoracentesis, respiratory distress, absent lung sound
• Lead-in keywords: most likely complication
• Clinical cues: The patient's symptoms developed immediately after an invasive procedure (thoracentesis), pointing to an iatrogenic complication.

Question ID

QWS_DIazvBhH4O0qaBbhWh

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 24-26

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 492-494