A client has a PRN prescription for a nasal cannula at 2 to 3 L/minute. The client is wearing a nasal cannula at 2 L/minute and asks the practical nurse (PN) if it can be removed. Which client data is most important for the PN to obtain before responding to the client?

This question requires knowledge of standardized blood glucose monitoring techniques. Understanding the proper sequence for obtaining a fingerstick sample is essential, specifically the rationale for removing the initial drop of blood to prevent diagnostic inaccuracies caused by localized tissue fluids and alcohol residue.

Choice A rationale: Applying direct pressure is a post-procedure step used to promote hemostasis after the sample has been collected. Doing this immediately after the prick would stop the bleeding before a sufficient sample could be obtained for the glucometer test strip.

Choice B rationale: The first drop of blood often contains high concentrations of serous fluid, interstitial fluid, or residual alcohol from the skin preparation. Wiping it away ensures that the second drop used for testing is pure capillary blood, providing a more accurate reading.

Choice C rationale: Cleaning the finger with alcohol must occur before the skin is punctured. Applying alcohol to an open wound after the prick is painful for the client and can interfere with the chemical reaction on the glucose test strip, leading to errors.

Choice D rationale: Applying the first drop directly to the test strip can lead to an inaccurate blood glucose result. Contamination from interstitial fluids or skin cleansers in the initial drop can artificially dilute or alter the glucose concentration measured by the device.

Choice A reason: Flushed, hot skin is not directly related to the client's CBC results. This symptom can indicate various conditions, such as fever, inflammation, or an allergic reaction, but it does not specifically correlate with the lab findings provided. The client's WBC count, hemoglobin, hematocrit, and basophils are within normal ranges, and the most significant abnormality is the low platelet count.
Choice B reason: Hives, or urticaria, are typically associated with allergic reactions and not directly related to the client's CBC results. While a low platelet count can sometimes be associated with immune-mediated conditions, hives are not a primary symptom of thrombocytopenia (low platelet count). The main concern with a low platelet count is the increased risk of bleeding and bruising.
Choice C reason: Inelastic turgor is a sign of dehydration or poor skin elasticity, often seen in conditions such as severe dehydration or malnutrition. The client's CBC results do not indicate dehydration or issues with skin turgor. The hemoglobin and hematocrit levels are within normal ranges, suggesting that the client's overall fluid status is likely stable.
Choice D reason: Bruising is the most relevant finding to assess for in a client with a low platelet count (thrombocytopenia). Platelets play a crucial role in blood clotting, and a low platelet count increases the risk of bleeding and easy bruising. The client's platelet count of 98,000/mm³ (98 x 10⁹/L) is below the normal range, which predisposes them to bruising and potential bleeding complications. It is important for the practical nurse to assess for signs of bruising and bleeding and to monitor the client closely for any further complications.