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Exhibits

Which laboratory tests would be helpful in determining the plan of care for this client? Select all that apply.

Coagulation studies

Type and screen

Urine osmolality

Complete blood count

Blood culture

Lipid panel

Arterial blood gas

Electrolytes

Answer and Explanation

Correct Answer : A,B,D,G,H

A. Coagulation Studies: This client has liver and spleen lacerations with blood noted in the peritoneum, increasing the risk of coagulopathy due to active bleeding. The liver is responsible for producing clotting factors, and an injury may impair coagulation. The client also has a low hemoglobin (9.3 g/dL) and hematocrit (30%), suggesting ongoing blood loss. Monitoring prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) can guide transfusion therapy (e.g., fresh frozen plasma or platelets).
B. Type and Screen: This client has evidence of hemorrhagic shock (tachycardia, narrow pulse pressure, low hemoglobin/hematocrit) and may require blood transfusion. Type and screen determines ABO blood type and Rh factor to ensure availability of compatible blood products. If bleeding worsens, crossmatching blood would be necessary for transfusion.
C. Urine osmolality: Not a priority in this trauma case. Urine osmolality assesses kidney function and hydration status but does not provide urgent information about blood loss, shock, or ventilation status.
D. Complete Blood Count (CBC): Provides serial hemoglobin and hematocrit (H&H) monitoring to assess for ongoing internal bleeding. White blood cell (WBC) count helps detect infection or inflammation post-operatively. Platelets are critical for clotting and must be monitored, especially in trauma patients at risk for coagulopathy.
E. Blood culture: Used to detect bloodstream infections (sepsis), which is not an immediate concern in this trauma patient. While infection risk is relevant postoperatively, it is not a priority test for acute trauma care.
F. Lipid panel: Lipid panels evaluate cholesterol and triglyceride levels, which are irrelevant in acute trauma management.
G. Arterial Blood Gas (ABG): This client is intubated and ventilated, making ABG analysis essential for evaluating: Oxygenation (PaO₂, SaO₂) and ventilation (PaCO₂), Acid-base balance (pH, bicarbonate levels). Early detection of metabolic acidosis, which may indicate shock or inadequate perfusion.
H. Electrolytes: Trauma and fluid resuscitation can cause electrolyte imbalances, leading to cardiac arrhythmias, fluid shifts, and metabolic disturbances. Potassium (K⁺) is Essential to monitor due to IV fluids with potassium chloride infusion. Sodium (Na⁺), chloride (Cl⁻), and bicarbonate (HCO₃⁻) are crucial in assessing fluid status and acid-base balance. Lactate levels (part of a metabolic panel) can indicate tissue hypoxia and worsening shock.

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Correct Answer is C

Explanation

A. Advancing to clear liquids is important for nutritional support but is secondary to ensuring urinary function is restored.

B. Urinary retention is a concern after anesthesia, but it is not an immediate threat. This intervention is conditional (“if unable to void”), meaning it is implemented only if needed.

C. Postoperative clients are at high risk for infection. Cefazolin (a broad-spectrum antibiotic) is a prophylactic measure to reduce the risk of surgical site infection, which is a priority intervention immediately after surgery. This should be implemented first, since infection prevention begins as soon as the client arrives from PACU.

D. A CBC is important for monitoring but is not urgent in comparison to immediate care needs like urinary output.

A. Measure and discard residual gastric contents before feeding. B. Use the syringe plunger to push formula at a rate of 5 mL/minute. C. Hold the infant with head and shoulders slightly elevated. D. Microwave refrigerated formula to room temperature.

Correct Answer is C

Explanation

A. Measure and discard residual gastric contents before feeding. Measuring residuals is a routine practice to ensure the stomach is empty, but it is not the priority in this situation unless the residual volume is significant.

B. Use the syringe plunger to push formula at a rate of 5 mL/minute. The formula should be administered gradually, but forcing it with a plunger could cause discomfort or complications.

C. Hold the infant with head and shoulders slightly elevated. This position helps prevent aspiration and promotes better digestion and comfort during feeding.

D. Microwave refrigerated formula to room temperature. Microwaving formula is not recommended, as it can cause uneven heating and create hot spots that could burn the infant's mouth. The formula should be warmed in a safe manner, such as with a bottle warmer.

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Exhibits Which laboratory tests would be helpful in determining the plan of care for this client? Select all that apply.

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Exhibits

Which laboratory tests would be helpful in determining the plan of care for this client? Select all that apply.