A nurse is caring for a client in the clinic.
The nurse anticipates which of the following orders from the provider based on the suspected diagnosis? (Select all that apply)
IV antibiotics
Urinalysis
Chest x-ray
Chest tube placement
Admit to inpatient
Airborne precautions
Draw an STI lab panel
Complete blood count
Correct Answer : A,C,E,H
The nurse anticipates the following orders from the provider based on the suspected diagnosis:
- A. IV antibiotics: To treat the suspected infection.
- C. Chest x-ray: To assess the lungs for signs of infection, such as pneumonia.
- E. Admit to inpatient: The client's worsening condition and need for aggressive treatment warrant hospitalization.
- H. Complete blood count: To assess the client's overall health status and identify any abnormalities, such as anemia or infection.
Rationale:
- B. Urinalysis: While a urinalysis can be helpful in assessing for urinary tract infections, it is not a priority in this case.
- D. Chest tube placement: This is not indicated unless the client develops a pleural effusion or pneumothorax.
- F. Airborne precautions: This is not necessary for the client's current condition.
- G. Draw an STI lab panel: While this may be relevant for the client's overall health, it is not a priority at this time, especially given the client's acute presentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Hepatitis is a concern for individuals with HIV, but it is not specifically indicated by a low CD4-T-cell count.
B. A CD4-T-cell count of 150/mm³ indicates severe immunosuppression, making the client highly susceptible to opportunistic infections like tuberculosis, which is common in individuals with HIV.
C. While gonorrhea is a risk for sexually active individuals, it is not specifically related to the low CD4-T-cell count.
D. Chlamydia is also a sexually transmitted infection, but similar to gonorrhea, it is not directly linked to the immunocompromised state indicated by the CD4-T-cell count.
Correct Answer is A
Explanation
A. Cardiac tamponade is a condition where fluid accumulates in the pericardial space, exerting pressure on the heart and impeding its ability to pump effectively, leading to obstructive shock.
B. Third spacing refers to fluid accumulation in the interstitial spaces but is not a specific diagnosis of obstructive shock.
C. A ruptured aneurysm may lead to hypovolemic shock due to blood loss rather than obstructive shock, which is characterized by physical obstruction to blood flow.
D. Cardiomyopathy is a disease of the heart muscle that affects its ability to pump blood, leading to cardiogenic shock, not obstructive shock.
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