A nurse is reviewing the diagnostic test results of a female client who is about to undergo knee arthroplasty. Which of the following data collection findings should the nurse identify as the priority?

Creatinine 0.9 mg/dL

WBC count 20,000/mm3

Potassium 3.8 mEq/L

Hematocrit 40%

Answer and Explanation

The Correct Answer is B

a. Creatinine 0.9 mg/dL: This creatinine level is within the normal range and is not an immediate priority for knee arthroplasty.

b. WBC count 20,000/mm3: An elevated white blood cell count suggests the presence of

infection or inflammation. In the context of knee arthroplasty, infection is a significant concern and requires immediate attention to prevent complications.

c. Potassium 3.8 mEq/L: This potassium level is within the normal range and is not an immediate priority for knee arthroplasty.

d. Hematocrit 40%: This hematocrit level is within the normal range and is not an immediate priority for knee arthroplasty. The elevated WBC count takes precedence as it suggests a

potential infectious process.

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Correct Answer is C

Explanation

a. Droplet precautions: Droplet precautions are used for diseases that are transmitted by

respiratory droplets, such as influenza or pneumonia. HIV is not transmitted through respiratory droplets.

b. Airborne precautions: Airborne precautions are used for diseases that are transmitted through the airborne route, such as tuberculosis. HIV is not transmitted through the airborne route.

c. Standard precautions: Standard precautions are used for the care of all patients, regardless of their diagnosis. These precautions include hand hygiene, use of personal protective equipment (PPE) as needed, and safe injection practices.

d. Contact precautions: Contact precautions are used for diseases that are spread by direct or indirect contact, such as methicillin-resistant Staphylococcus aureus (MRSA). HIV is not

transmitted through contact with intact skin.

A. Inspiratory stridor B. Expiratory wheeze C. Coarse crackles D. Absence of breath sounds.

Correct Answer is D

Explanation

A. Inspiratory stridor - This is associated with upper airway obstruction and is not indicative of a pneumothorax.

B. Expiratory wheeze - Wheezing is commonly associated with lower airway conditions such as asthma or chronic obstructive pulmonary disease (COPD), not pneumothorax.

C. Coarse crackles - Coarse crackles are typically heard in conditions such as pneumonia or pulmonary edema, not pneumothorax.

D. Absence of breath sounds - This is a key manifestation of a pneumothorax. The air in the pleural space can prevent the lung from fully expanding, leading to the absence of breath sounds on the affected side.

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