Exhibits

A nurse is reviewing the medical record of a client who has COPD. Which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Platelet count

Sputum color

Temperature

Fluid intake

Answer and Explanation

The Correct Answer is C

A. Platelet count is normal (175,000/mm3) and does not require reporting to the provider.

B. Sputum color: While thick green sputum might suggest infection, the nurse should first assess for other clinical signs, and it might not need immediate reporting unless there are other concerns, like a change in respiratory status.

C. Temperature (38°C / 100.4°F) is elevated, which could indicate an infection, such as a respiratory infection or exacerbation of COPD. This finding should be reported to the provider because fever in a client with COPD could lead to complications like pneumonia or exacerbation of symptoms.

D. Fluid intake of 2,200 mL/24 hr is within normal limits and does not need reporting.

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Correct Answer is C

Explanation

A. Decreased body temperature is incorrect. A thyroid storm is characterized by a hypermetabolic state, so a decreased body temperature would be inconsistent with the condition. In fact, patients with thyroid storm typically have increased body temperature (fever).

B. Increased incisional drainage is incorrect. While increased drainage could indicate a wound infection or other surgical complications, it is not a primary indicator of thyroid storm, which involves a hyperactive thyroid response.

C. Hypertension is correct. Thyroid storm is a severe, acute exacerbation of hyperthyroidism, and it is associated with hypertension, tachycardia, fever, and other symptoms of sympathetic nervous system overactivity.

D. Bradycardia is incorrect. Bradycardia would be expected in conditions like hypothyroidism, not thyroid storm. Thyroid storm typically presents with tachycardia, which is a hallmark sign.

A. A nurse discusses a client's postoperative complications during shift report. B. A facility risk manager includes information from a client's medical record in a when report. C. A nurse tells the chaplain that a client has a new diagnosis of cancer. D. A social worker reads a client's chart as a follow-up to a requested consultation.

Correct Answer is C

Explanation

A. "A nurse discusses a client's postoperative complications during shift report.": This is not a breach of confidentiality if the information is shared within the context of a healthcare team for the purpose of providing care. Confidentiality is maintained as long as the information is shared appropriately.

B. "A facility risk manager includes information from a client's medical record in a when report.": This is also not necessarily a breach of confidentiality if the report is used for quality improvement, risk management, or other institutional purposes where confidentiality protocols are followed.

C. "A nurse tells the chaplain that a client has a new diagnosis of cancer.": This is a breach of confidentiality. Information should only be shared with others involved in the patient's care or if the patient has given explicit consent. Discussing a client's diagnosis with a chaplain or anyone not directly involved in the care plan is an unauthorized disclosure.

D. "A social worker reads a client's chart as a follow-up to a requested consultation.": This is not a breach of confidentiality if the social worker is following established protocols for patient care and is authorized to access the client's medical records for consultation purposes.

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Exhibits A nurse is reviewing the medical record of a client who has COPD. Which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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Exhibits

A nurse is reviewing the medical record of a client who has COPD. Which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)