An adult male client is admitted to the medical unit because of a loss of appetite and generalized malaise. His complete blood count (CBC) results indicate a white blood cell (WBC) count of 8,000/mm³ (8 x 10⁹/L), basophils 1% (0.01 fraction), platelets 98,000/mm³ (98 x 10⁹/L), hemoglobin of 14 g/dL (8.7 mmol/L), and hematocrit of 44.9% (0.44 volume fraction). The practical nurse (PN) should assess the client for which finding?

Reference Range:

• White Blood Cell (WBC): 5,000 to 10,000/mm³ (5 to 10 x 10⁹/L)
• Basophils: 0.5 to 1.0% (0.01 to 0.05 x 10⁹/L)
• Platelets: 150,000 to 400,000/mm³ (150 to 400 x 10⁹/L)
• Hemoglobin (Hgb): 14 to 18 g/dL (8.69 to 11.17 mmol/L)
• Hematocrit (Hct): 42% to 52% (0.42 to 0.52 volume fraction)

Choice A reason: While the apical heart rate is important for overall health assessment, it is not the most critical data point to consider before deciding if a client can discontinue oxygen therapy. Oxygen saturation provides more direct information about the client's respiratory status.
Choice B reason: Breath sounds are important in assessing a client's respiratory condition, but they are not as immediately indicative of whether the client can safely discontinue using the nasal cannula. Oxygen saturation levels give a more precise measurement of the client's oxygen needs.
Choice C reason: Oxygen saturation is the most important data to obtain before responding to the client's request. It directly measures the percentage of oxygen in the client's blood, providing a clear indication of whether the client is receiving adequate oxygen while on the nasal cannula. Ensuring that the client's oxygen saturation is within a safe range is crucial before considering the removal of the oxygen support.
Choice D reason: Blood pressure is another vital sign that provides important health information, but it does not give a direct indication of the client's oxygenation status. Oxygen saturation is a more relevant measure when determining if the nasal cannula can be safely removed.

Choice A reason: Commending the client for ensuring an adequate source of vitamin C in the diet is not the best response. While vitamin C is important for overall health, it does not directly impact bone density. The client's focus on orange juice may stem from a misunderstanding of the nutrients that are critical for bone health, such as calcium and vitamin D. A better approach would be to address the specific nutrients that support bone density and clarify any misconceptions.
Choice B reason: Advising the client of the need to remain NPO (nothing by mouth) until the test is completed is not necessary for a bone density test. Bone density tests, such as dual-energy X-ray absorptiometry (DEXA) scans, do not require the client to fast beforehand. Providing this advice would be incorrect and could cause unnecessary concern or confusion for the client.
Choice C reason: Determining if the client drinks orange juice that has been fortified with calcium is a helpful step, but it does not address the immediate need to correct the client's misunderstanding about the purpose of the bone density test. While calcium-fortified orange juice can be beneficial for bone health, the priority should be to ensure the client has accurate information about the test they are undergoing.
Choice D reason: Correcting the client's misunderstanding of the purpose of bone density testing is the most appropriate response. The primary goal of a bone density test is to measure the density of the bones and assess the risk of fractures, not to diagnose or confirm the presence of osteoporosis. By providing clear and accurate information about the test, the practical nurse can help the client understand its purpose and alleviate any misconceptions. This response also opens the door for further education on managing osteoporosis and ensuring the client is receiving the necessary nutrients for bone health.