A nurse is preparing an adolescent client who has pneumonia for percussion, vibration, and postural drainage. Prior to the procedure, which of the following nursing actions should the nurse complete first?

Choice A rationale
The skin assessment reveals bruising and petechiae, which are signs of thrombocytopenia, a condition where the blood has a lower than normal number of platelets. This is significant in a child with leukemia as it may indicate a relapse or bone marrow suppression. The presence of petechiae and unexplained bruising should be reported to the provider as they can be indicative of bleeding disorders or a decrease in platelet count.
Choice B rationale
Oxygen saturation of 92% on room air is below the normal range (95-100%) for a child. This indicates hypoxemia, which can be a sign of respiratory distress or other underlying conditions. Given the child’s history of an upper respiratory infection and leukemia, this finding is critical and should be reported to the provider to ensure appropriate interventions are taken to improve oxygenation.
Choice C rationale
The WBC count is crucial in a child with leukemia. An abnormal WBC count can indicate an infection, relapse, or bone marrow suppression. Monitoring the WBC count helps in assessing the child’s immune status and the effectiveness of the leukemia treatment. Any significant changes in the WBC count should be reported to the provider for further evaluation and management.
Choice D rationale
Subcostal retractions are a sign of increased work of breathing and respiratory distress. This finding, along with the child’s statement of feeling like they can’t breathe, indicates that the child is struggling to maintain adequate ventilation. Reporting this to the provider is essential for timely intervention to prevent further respiratory compromise.
Choice E rationale
An ongoing upper respiratory infection for the last 2 months that has not resolved is concerning, especially in a child with a history of leukemia. This could indicate an underlying immunodeficiency or a more serious infection that requires further investigation and treatment. Reporting this to the provider is necessary to address the persistent infection and prevent complications.
Choice G rationale
The respiratory rate is an important vital sign that can indicate respiratory distress or other underlying conditions. An abnormal respiratory rate, whether too high or too low, can be a sign of respiratory or metabolic issues. Monitoring and reporting the respiratory rate to the provider helps in assessing the child’s respiratory status and determining the need for further intervention.

Choice A rationale
Prostate cancer mortality is more than double for Black American males than for other groups. This is a significant consideration when creating a plan of care for prostate screening in high- risk populations. Black American males have a higher incidence and mortality rate of prostate cancer compared to other racial and ethnic groups. This disparity is attributed to a combination of genetic, socioeconomic, and healthcare access factors. Therefore, targeted screening and early detection efforts are crucial for this high-risk population to improve outcomes and reduce mortality rates.
Choice B rationale
Occupational toxic exposure among factory workers can increase the risk of various cancers, including prostate cancer. However, this is not the most important consideration when creating a plan of care for prostate screening in high-risk populations. While occupational exposure is a risk factor, it does not have the same level of impact on prostate cancer incidence and mortality as race and family history. Screening efforts should prioritize those with the highest risk, such as Black American males and individuals with a family history of prostate cancer.
Choice C rationale
Dietary factors can influence the risk of prostate cancer, but the impact is not as significant as other risk factors such as race and family history. While a healthy diet is important for overall health and may help reduce cancer risk, it is not the primary consideration for prostate screening in high-risk populations. Screening efforts should focus on those with the highest risk based on genetic and demographic factors, rather than dietary habits alone.
Choice D rationale
A computed tomography (CT) scan is not the best way to determine prostate cancer risk. The primary screening method for prostate cancer is the prostate-specific antigen (PSA) blood test, often combined with a digital rectal exam (DRE). CT scans are not typically used for initial screening but may be employed for further evaluation if there are abnormal findings on PSA or DRE. The focus should be on using established screening methods to identify high-risk individuals and provide early detection and intervention.