A nurse is assessing a client who has a new diagnosis of colon cancer. Which of the following findings should the nurse expect?

Rationale:

A. Weak peripheral pulses on palpation: Weak peripheral pulses can indicate poor circulation or low cardiac output, which is not a therapeutic response to synchronized cardioversion. The goal is to restore a normal rhythm and improve perfusion.

B. Cardiac monitor indicates sinus rhythm: Sinus rhythm on the cardiac monitor indicates that the cardioversion was successful in restoring a normal heart rhythm, making this the therapeutic response. This is the desired outcome after synchronized cardioversion.

C. Diminished breath sounds on auscultation: Diminished breath sounds are more indicative of respiratory issues, such as fluid in the lungs or atelectasis, and are not related to the effectiveness of synchronized cardioversion.

D. Pacer spikes precede the QRS complex on the ECG tracing: Pacer spikes are seen in patients with a pacemaker, not typically following synchronized cardioversion. If pacer spikes are seen, it indicates that pacing is occurring, which may be necessary in some situations, but it is not a sign of the success of cardioversion.

Rationale for Correct Choices:

• Antibiotic therapy: The client’s symptoms (flank pain, painful urination, reddish-brown urine), elevated white blood cell count (15,000/mm³), positive nitrites, leukocyte esterase, and blood in the urine suggest a urinary tract infection (UTI) or pyelonephritis. Antibiotics are needed to treat this infection.
• Urinary tract infection: The urinalysis findings of turbid, dark red urine with blood, positive nitrites, and leukocyte esterase, along with symptoms like painful urination, flank pain, and fever, strongly point to a UTI, possibly involving the kidneys.

Rationale for Incorrect Choices:

• Lithotripsy: Lithotripsy is used for kidney stones, but the client’s symptoms don’t suggest kidney stones, as there is no sharp, colicky pain. The symptoms are more aligned with a UTI.
• Indwelling urinary catheter: An indwelling catheter is not needed for this UTI unless there’s urinary retention. The client's main issue is a UTI, and there is no mention of retention or obstruction requiring a catheter.
• Kidney failure: Although BUN and creatinine are elevated, the primary issue is a UTI, not kidney failure. Kidney failure would be characterized by more severe, prolonged renal dysfunction.
• Pneumonia: The symptoms do not suggest pneumonia. The primary symptoms of pneumonia include cough and difficulty breathing, which are not present here. Crackles are more likely due to fluid overload.