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: Fat embolism syndrome (FES) is a serious complication that can occur after a long bone fracture. It happens when fat droplets from the bone marrow enter the bloodstream and travel to the lungs, brain, or other organs, causing a range of symptoms. These can include respiratory distress, cerebral symptoms like confusion or agitation, and petechial rash. The practical nurse must be vigilant for early signs of fat embolism, such as changes in mental status, tachypnea, and hypoxia, as timely intervention is critical to prevent severe outcomes. Monitoring the client's oxygen saturation, respiratory rate, and level of consciousness is essential in detecting this potentially life-threatening condition.
Choice B reason: Urinary retention can be a concern postoperatively due to anesthesia and immobility. While it is important to monitor urinary output and ensure the client is voiding adequately, urinary retention is not as immediately life-threatening as a fat embolism. The practical nurse should still assess bladder function and encourage measures to promote voiding, such as adequate hydration and mobility. However, this complication does not take precedence over the potential for a fat embolism in the early postoperative period following a long bone fracture repair.
Choice C reason: Nonunion refers to the failure of the fracture to heal properly, which can lead to chronic pain and functional impairment. It is a significant complication that requires attention, but it typically develops over a longer period rather than immediately postoperatively. The practical nurse should monitor for signs of nonunion, such as persistent pain and lack of healing on follow-up X-rays. However, this is not the most urgent concern in the immediate postoperative period when compared to the risk of a fat embolism.
Choice D reason: Muscular spasms can occur after a fracture as the muscles around the injury site contract to protect and stabilize the affected area. While muscle spasms can be painful and affect the client's comfort and mobility, they are generally not life-threatening. The practical nurse should address muscle spasms through pain management strategies and physical therapy, but this complication is not as critical as the potential for a fat embolism in the immediate postoperative period.