A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count

Place the client on bleeding precautions.

Place the client in a private room.

Document findings in the client's chart

Collect blood cultures and start antibiotics.

Answer and Explanation

The Correct Answer is B

A. Bleeding precautions are not required as the issue pertains to neutropenia, not thrombocytopenia.

B. Placing the client in a private room is appropriate as the ANC calculation (WBC × [% neutrophils]) indicates severe neutropenia, increasing the risk of infection.

C. Simply documenting findings does not address the client’s increased infection risk.

D. Blood cultures and antibiotics may be needed later but require additional signs of infection to proceed.

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Correct Answer is C

Explanation

A. Epinephrine is used in cases of severe allergic reactions or anaphylaxis, and while it may be appropriate in treating angioedema, the first priority is to ensure the airway is clear and that the client can breathe. Administering epinephrine may be part of the treatment plan but should follow securing the airway and calling for immediate advanced help.

B. This is not appropriate because angioedema can be life-threatening and can rapidly progress to airway obstruction. Reassurance without action would delay necessary interventions and could jeopardize the client’s safety.

C. In cases of angioedema, airway obstruction is the most dangerous complication, as it can lead to asphyxiation. The nurse's first priority is to ensure that the patient's airway remains open and clear. The nurse should immediately call the Rapid Response Team (RRT) for urgent medical intervention, which may include medications (like epinephrine), intubation, or other interventions. Ensuring the airway is open and calling for advanced help are the most critical first steps in managing severe cases of angioedema.

D. While oxygen therapy may be appropriate if the client shows signs of respiratory distress or hypoxia, the immediate concern is securing the airway. Oxygen may be needed after ensuring the airway is open, but the priority is to avoid airway obstruction first. The nurse should secure the airway and then administer oxygen if needed.

A. P wave touching the T wave B. Midsternal chest pain C. Increased urine output D. Mild orthostatic hypotension

Correct Answer is B

Explanation

A. P wave touching the T wave can indicate an issue but is less urgent than chest pain.

B. Midsternal chest pain could indicate myocardial ischemia or infarction, requiring immediate intervention.

C. Increased urine output is not an urgent concern in this context.

D. Mild orthostatic hypotension is not as urgent as chest pain.

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A client admitted to a medical - surgical unit has a CBC with differential drawn. Lab results show a WBC count of 4000, with neutrophil segments at 5% and neutrophil bands at 5%. Based on these values what would the nurse do? Calculate the absolute neutrophil count

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is in the hospital and has received two doses of an angiotensin-converting enzyme (ACE) inhibitor for hypertension. When the nurse answers the client's call light, the client presents an appearance as shown below. What action by the nurse is most appropriate?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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