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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Sodium intake with meals and snacks affects the blood pressure. While sodium can contribute to blood pressure increases, the primary reason for monitoring blood pressure in this case is to detect the kidney-related hypertension.
B. Elevated blood pressure must be anticipated and identified quickly. Blood pressure can increase significantly in acute glomerulonephritis due to fluid retention and kidney impairment. Frequent monitoring helps to identify and treat elevated blood pressure early, preventing complications.
C. Blood pressure fluctuations mean that the condition has become chronic. Acute glomerulonephritis typically causes fluctuating blood pressure, but this does not necessarily indicate chronic disease.
D. Hypotension leading to sudden shock can develop at any time. Hypotension is less common in acute glomerulonephritis compared to hypertension, making this response less accurate.
Correct Answer is A
Explanation
A. Ask the client about individual care preferences: This is the most respectful approach. It allows the client to express specific needs or concerns related to their religious beliefs and ensures their preferences are honored.
B. Research the religion on different social media platforms: Research on social media platforms may not provide accurate or comprehensive information about the client's religion.
C. Explain that every client will receive the same high level of care: While this is true, it does not address the client's specific concerns about religious care preferences.
D. Consult with a nurse who shares the same religious beliefs: This may not be the best approach, as care should be based on the client's needs rather than the nurse's personal beliefs.
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