A client is admitted with cough, congestion, bilateral rales, and clear nasal drainage. In reviewing the differential WBC the nurse notes the lymphocytes are elevated. How should the nurse interpret the elevated lymphocytes?
as an allergic response
as an inflammatory response
as a viral infection
as a bacterial infection
The Correct Answer is C
A. Allergic responses typically involve an increase in eosinophils rather than lymphocytes.
B. While an inflammatory response may involve an increase in lymphocytes, the presentation of clear nasal drainage and cough with bilateral rales suggests a respiratory infection rather than a generalized inflammatory process.
C. Elevated lymphocytes are often indicative of a viral infection, as the body mounts an immune response to fight off the viral invader.
D. Bacterial infections typically involve an increase in neutrophils rather than lymphocytes, although lymphocytosis may occur in some bacterial infections as part of the immune response.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Neutropenic precautions are implemented when the white blood cell count is significantly decreased, typically below 1,000/mm3, to protect the client from potential infections due to compromised immunity.
B. Hematocrit level and hemoglobin levels are indicators of red blood cell function and oxygen-carrying capacity and are not directly related to neutropenia.
C. Hemoglobin levels are an indicator of oxygen-carrying capacity and are not directly related to neutropenia.
D. Platelet count is related to clotting function and is not directly related to neutropenia.
Correct Answer is ["A","B","C","F"]
Explanation
A. The client's signs and symptoms, including crackles on auscultation and difficulty breathing, warrant a chest x-ray to assess for possible pneumonia or other respiratory conditions.
B. Obtaining a sputum culture can help identify the causative organism and guide antibiotic therapy for respiratory infection.
C. Antibiotic therapy is indicated for the treatment of respiratory infection, especially if the sputum culture indicates bacterial involvement.
D. There is no indication for inserting a Foley catheter based on the client's signs and symptoms.
E. Nasogastric tube insertion for decompression is not indicated based on the client's respiratory symptoms.
F. Oxygen therapy is indicated for the client's low oxygen saturation level and respiratory distress. Applying oxygen at 2L per nasal cannula can help improve oxygenation.
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