A client with leukemia who is receiving chemotherapy has a hemoglobin of 10 g/dL (6.21 mmol/L), hematocrit of 38% (0.38 volume fraction), a white blood cell (WBC) count of 2,500/mm³ (2.5 x 10⁹/L), and a platelet count of 250,000/mm³ (250 x 10⁹/L). Which is the most significant problem that the practical nurse (PN) should consider when planning care for this client?

Reference Range:

• Hemoglobin (Hgb): 14 to 18 g/dL (8.69 to 11.17 mmol/L)
• Hematocrit (Hct): 42% to 52% (0.42 to 0.52 volume fraction)
• White Blood Cell (WBC): 5,000 to 10,000/mm³ (5 to 10 x 10⁹/L)
• Platelets: 150,000 to 400,000/mm³ (150 to 400 x 10⁹/L)

Choice A reason: A respiratory rate of 28 breaths per minute indicates tachypnea, which can be a response to pain, anxiety, or hypovolemia. While it is important to monitor and manage respiratory status, this finding alone is not as critical as urine output when assessing the client's overall condition and fluid balance. Tachypnea should be reported, but it is not the most urgent parameter in this scenario.
Choice B reason: A blood pressure of 110/90 mm Hg is within a range that might be acceptable for some individuals, though the pulse pressure is narrow. In the context of a client receiving blood and fluid replacement, it is important to monitor blood pressure closely to ensure adequate perfusion. However, this reading does not immediately suggest a severe complication or shock, and other parameters might take precedence for immediate reporting.
Choice C reason: Urine output of 20 mL in the last hour is significantly low, indicating potential renal hypoperfusion or early signs of shock. Adequate urine output is a crucial indicator of renal perfusion and overall fluid status. Oliguria (reduced urine output) in this context suggests that the client's organs may not be receiving sufficient blood flow, which is a critical condition that requires prompt intervention. This finding should be reported immediately to the charge nurse to ensure timely and appropriate management.
Choice D reason: A pain score of 8 out of 10 indicates severe pain, which needs to be managed effectively to ensure the client's comfort and prevent further physiological stress. While addressing pain is important, it does not directly indicate a life-threatening condition compared to low urine output. Pain management should be part of the overall care plan, but reporting the critically low urine output takes priority in this situation.

Choice A reason: Smoking two packs of cigarettes a day is highly significant in planning the client's rehabilitation following a myocardial infarction. Smoking is a major risk factor for cardiovascular disease, and continuing to smoke can significantly hinder recovery and increase the risk of future cardiac events. Addressing this behavior is crucial for improving the client's long-term health outcomes. Smoking cessation should be a primary focus of the rehabilitation plan, and the client should be provided with resources and support to quit smoking, such as counseling, nicotine replacement therapy, or medications.
Choice B reason: Expressing a desire to change one's lifestyle is a positive and encouraging sign. It indicates the client's motivation to adopt healthier habits, which is essential for successful rehabilitation. However, while this is important, the immediate focus should be on addressing specific risk factors, such as smoking, that have a direct and significant impact on the client's recovery and future health. The desire to change is a valuable component of the rehabilitation process, but it should be coupled with targeted interventions to address critical behaviors like smoking.
Choice C reason: Drinking 1 to 2 glasses of red wine daily may have both positive and negative health implications. Moderate alcohol consumption has been suggested to have some cardiovascular benefits, but it can also pose risks, especially if not monitored. While this information is relevant to the client's overall lifestyle, it is not as immediately critical as addressing smoking, which has a well-documented and direct impact on cardiovascular health. The client's alcohol consumption can be discussed as part of the broader lifestyle changes during rehabilitation.
Choice D reason: Walking four city blocks to work each day indicates a level of physical activity that is beneficial for cardiovascular health. Encouraging regular physical activity is an essential part of the rehabilitation process. However, compared to the impact of smoking, this information is less critical in the immediate planning of the client's rehabilitation. The focus should be on eliminating harmful behaviors like smoking, while also promoting continued and possibly increased physical activity as part of a comprehensive rehabilitation plan.