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Exhibits

Select the 2 findings that indicate the client's condition is improving.

Temperature

Blood glucose

WBC

Heart rate

Urinary frequency

Blood pressure

Wound appearance

Answer and Explanation

Correct Answer : B,E

Rationale for Correct Choices

Blood glucose: The client’s blood glucose decreased from 250 mg/dL to 140 mg/dL, indicating a positive response to diabetes management through medication and dietary adherence. This is a key marker of metabolic control in diabetes.
Urinary frequency: Two weeks ago, the client reported "frequent urination" (polyuria), which is a classic symptom of uncontrolled hyperglycemia. Today, this symptom is not reported, and given the improvement in blood glucose, it's highly probable that the polyuria has resolved or significantly decreased.

Rationale for Incorrect Choices

Temperature: The client’s temperature increased from 38.3°C to 39.0°C, suggesting a worsening or persistent infection. An increasing fever is a negative trend and does not indicate improvement.
WBC: The WBC count rose from 9,500/mm³ to 11,200/mm³, exceeding the normal upper limit. This may reflect an active or worsening infection, especially in the context of a draining foot wound and elevated temperature.
Heart rate: The heart rate remains elevated at 106/min (tachycardia) compared to the previous 104/min. Persistent tachycardia can be a sign of systemic infection or dehydration and is not a sign of clinical improvement.
Blood pressure: The blood pressure decreased from 98/74 mm Hg to 90/68 mm Hg, which may suggest worsening hemodynamic status and possible sepsis. Hypotension is not an indicator of improvement.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Flush the PICC line with 0.9% sodium chloride after medication administration: This is essential to maintain patency and prevent occlusion as it helps clear any medication residue from the line and ensures proper blood flow.

B. Monitor for a pneumothorax following insertion of the PICC line: A pneumothorax is a potential complication following the insertion of a central venous catheter in the subclavian or internal jugular vein, not typically associated with PICC line insertion.

C. Use a 3 mL syringe when flushing the PICC line: A 10 mL or larger syringe is recommended. Using a 3 mL syringe could generate high pressure, causing damage to the PICC line or the vein, leading to complications such as catheter rupture or vein injury.

D. Expect the PICC line to be inserted into a lower extremity vein: PICC lines are typically inserted into veins in the upper extremities, such as the basilic or cephalic veins. Inserting a PICC line into a lower extremity vein can increase the risk of complications such as DVT.

A. Increased urine output B. Petechiae C. Decreased respirations D. Bradycardia

Correct Answer is B

Explanation

A. Increased urine output: In disseminated intravascular coagulation (DIC), there is typically decreased urine output due to renal failure or microvascular clotting, not increased output.

B. Petechiae: Petechiae are small red or purple spots on the skin caused by bleeding under the skin. This is a common finding in DIC due to widespread clotting and subsequent bleeding, resulting in tiny hemorrhages.

C. Decreased respirations: Respiratory rate may actually increase in DIC due to hypoxia, sepsis, or pulmonary embolism rather than decrease. Respiratory complications are common in DIC.

D. Bradycardia: Bradycardia (slow heart rate) is not a typical finding in DIC. Instead, tachycardia (increased heart rate) is often observed as a compensatory response to hypovolemia or shock associated with DIC.

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Exhibits Select the 2 findings that indicate the client's condition is improving.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who requires insertion of a peripherally inserted central catheter (PICC) line. Which of the following actions should the nurse plan to take?

Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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Exhibits

Select the 2 findings that indicate the client's condition is improving.