A client is admitted with the diagnosis of possible pneumonia, and laboratory studies are prescribed to rule out the etiology. Which specimen should the practical nurse (PN) collect prior to the beginning of antibiotic therapy?

Choice A reason: Fat emboli, or fat embolism syndrome (FES), is the most critical complication to monitor for in a client who had a long bone fracture repaired. This condition occurs when fat droplets from the bone marrow enter the bloodstream and travel to the lungs, brain, or other organs. Symptoms can include respiratory distress, confusion, and a petechial rash. FES can develop within 24 to 72 hours after the injury or surgery and can be life-threatening. Therefore, it is essential to observe for signs such as sudden shortness of breath, rapid breathing, changes in mental status, and the characteristic rash. Early detection and intervention are crucial to manage this potentially severe complication.
Choice B reason: Urinary retention is a possible postoperative complication due to anesthesia or immobility. It is important to monitor urine output and ensure that the client is voiding adequately. However, it is not as immediately life-threatening as a fat embolism. While urinary retention requires attention and management, the practical nurse should prioritize monitoring for signs of fat embolism due to its more severe and acute nature.
Choice C reason: Nonunion refers to the failure of the fracture to heal properly, which can lead to chronic pain and functional impairment. This complication typically develops over a more extended period rather than immediately postoperatively. Monitoring for signs of nonunion, such as persistent pain and lack of healing on follow-up X-rays, is important. However, it is not the most urgent concern in the immediate postoperative period when compared to the risk of a fat embolism.
Choice D reason: Muscular spasms can occur after a fracture as the muscles around the injury site contract to protect and stabilize the affected area. These spasms can be painful and impact the client's comfort and mobility. While it is necessary to address muscle spasms through pain management and physical therapy, they are generally not life-threatening. The practical nurse should focus on monitoring for signs of fat embolism, which poses a more immediate risk to the client's health.

Choice A reason: Evaluating neuro vital signs includes assessing the client's level of consciousness, pupil response, motor function, and other neurological indicators. While important for overall assessment, changes in neurological status are not the most immediate concern in the context of heart failure and the client's request for more pillows. The request may be related to orthopnea, a common symptom of heart failure where clients experience difficulty breathing while lying flat.
Choice B reason: Monitoring urinary output is crucial for assessing kidney function and fluid balance, especially in clients with heart failure. However, it does not directly address the client's symptom of needing more pillows to sleep, which is more likely related to respiratory discomfort. While maintaining adequate urinary output is important, it is not the primary assessment needed in this scenario.
Choice C reason: Blood pressure is a vital sign that needs regular monitoring in clients with heart failure, as it can indicate fluid status and cardiac function. However, the need for additional pillows to sleep is more directly related to respiratory issues rather than blood pressure alone. While important, it is not the primary focus in response to the client's specific request.
Choice D reason: Evaluating breath sounds is the most relevant assessment when a client with heart failure requests more pillows to sleep. This request often indicates orthopnea, where the client has difficulty breathing while lying flat due to fluid accumulation in the lungs (pulmonary congestion). By assessing breath sounds, the PN can detect signs of crackles, wheezing, or decreased air entry, which may indicate worsening heart failure or pulmonary edema. Prompt assessment and intervention are crucial to address respiratory distress and prevent further complications.