A nurse is reinforcing teaching with a client who has cancer and is undergoing external radiation therapy. Which of the following instructions should the nurse include in the teaching?

B. A chest X-ray: The client’s symptoms (cough, blood-tinged sputum, night sweats, fever, and weight loss) are concerning for tuberculosis (TB) or another pulmonary infection. A chest X-ray is a key diagnostic tool to assess for lung abnormalities, including TB infiltrates or cavitations.

D. A Mantoux test: The Mantoux tuberculin skin test (TST) is used to screen for Mycobacterium tuberculosis infection. Given the client’s recent travel to South Africa, a high TB prevalence area, and their symptoms, TB testing is crucial.

Incorrect:

A. A pulmonary function test: This evaluates chronic respiratory conditions like asthma or COPD, but is not a first-line test for an acute cough with systemic symptoms.

C. A nasopharyngeal swab: This is used for diagnosing viral infections like influenza or COVID-19, which are less likely given the client’s blood-tinged sputum and prolonged systemic symptoms.

E. Blood cultures: These are used to detect bacteremia or sepsis, but there is no indication of systemic bacterial infection (e.g., hemodynamic instability, severe leukocytosis).

A) Medical health insurance claims:
Medical health insurance claims are not relevant to the referral for physical therapy. This information is typically handled by billing departments and insurance providers. The focus of a physical therapy referral is on the patient's clinical condition and needs, not their insurance coverage.

B) Physical assessment findings:
This is the most relevant information to include in a referral for physical therapy. The physical assessment findings provide the physical therapist with important details about the client's mobility, strength, range of motion, and other factors that can guide the creation of an individualized therapy plan. These findings help the therapist understand the client's current physical capabilities and limitations.

C) Medications taken prior to admission:
While it is important for the healthcare team to be aware of the medications a client is taking, this information is not as crucial for the physical therapy referral itself. The physical therapist may need to know about medications if they have a direct impact on the client's physical functioning (e.g., sedatives or pain medications), but the primary focus for the referral would be on the physical assessment findings.

D) Family medical history:
Family medical history is typically relevant to a broader health assessment but is not generally included in a referral for physical therapy. The therapist will be more concerned with the client's current physical condition and functional abilities rather than the medical history of the client's family.