A nurse on a medical-surgical unit is caring for a newly admitted client with a diagnosis of R/O tuberculosis.

Which of the following findings should the nurse report to the provider?

Nurses' Notes

Day 1:

0900:

Client admitted from emergency department with hemoptysis, dull chest pain, increasing fatigue, anorexia, nausea, chest tightness, and 3.2 kg (7 Ib) weight loss in 2 weeks. Heart rate regular, lung sounds with crackles in bilateral upper lobes. No edema. Airborne precautions initiated upon admission.

Day 2:

Client reports shortness of breath, nausea, and fatigue. Crackles auscultated bilaterally throughout lung fields. Productive cough, with thick, blood-streaked sputum. Bowel sounds active, no edema.

Yellow sclera

Increasing AST level

Weight loss

Mantoux test result

Answer and Explanation

The Correct Answer is A

This is because tuberculosis can affect the liver and cause hepatotoxicity, especially if the client is taking anti-tuberculosis medications. The nurse should monitor the client's liver function tests, such as AST and ALT levels, and observe for signs of liver damage, such as yellow sclera, dark urine, clay-colored stools, and abdominal pain.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is D

Explanation

The correct answer is choiceD. Fresh flowers and potted plants in the room.

Choice A rationale:

While activities that could result in bleeding should be avoided in patients with low platelet counts, this is not directly related to neutropenia.Neutropenia primarily increases the risk of infection rather than bleeding.

Choice B rationale:

Restricting oral fluid intake to between meals is not relevant to managing neutropenia.Adequate hydration is important, but the timing of fluid intake does not impact neutropenia management.

Choice C rationale:

While limiting visitors can help reduce the risk of infection, it is not necessary to restrict all visitors.Instead, visitors should follow strict hygiene practices, such as handwashing and wearing masks, to minimize infection risk.

Choice D rationale:

Fresh flowers and potted plants can harbor bacteria and fungi, which pose a significant infection risk to neutropenic patients.Therefore, these should be avoided in the patient’s room.

A. Gelatin B. Yeast C. Eggs D. Shellfish

Correct Answer is C

Explanation

This is because some influenza vaccines are prepared using chicken eggs and may contain trace amounts of egg protein, which can cause an allergic reaction in some people.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is being treated with chemotherapy and radiation for metastatic breast cancer, and who has neutropenia. The nurse should include which of the following restrictions in the client's plan of care?

Correct Answer is D

Explanation

A nurse in a community health clinic is administering seasonal inactive influenza vaccine. Before administering it, the nurse must confirm that the client is not allergic to which of the following?

Correct Answer is C

Explanation

A nurse is teaching a client who has tuberculosis and is to start combination drug therapy. Which of the following medications should the w plan to administer? (Select all that apply.)

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A nurse in a provider's office is assessing a client who has AIDS. The nurse notes that the client has multiple and widespread raised, purplish- brown skin lesions. The nurse should recognize that these findings indicate which of the following conditions?

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

A nurse in an emergency room is caring a the client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?

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