The practical nurse (PN) is assigned to care for a client with Guillain-Barré syndrome (GBS). Which problem has the highest priority for this client's care?

Choice A reason: Aldosterone is a hormone produced by the adrenal cortex that helps regulate sodium and potassium levels in the body. While aldosterone levels can indicate adrenal function, they are not as commonly used as cortisol levels in diagnosing adrenal cortex failure. Aldosterone regulation is also influenced by the renin-angiotensin-aldosterone system, making it a less direct indicator of overall adrenal cortex function compared to cortisol.
Choice B reason: Cortisol is a glucocorticoid hormone produced by the adrenal cortex and plays a vital role in regulating metabolism, immune response, and stress. Measuring cortisol levels is a primary method for assessing adrenal cortex function. Low cortisol levels can indicate adrenal insufficiency or failure, such as in conditions like Addison's disease. Evaluating cortisol levels provides a direct assessment of the adrenal gland’s ability to produce essential hormones necessary for the body's normal functioning.
Choice C reason: Thyroxine (T4) is a hormone produced by the thyroid gland, not the adrenal cortex. It plays a crucial role in regulating metabolism, growth, and development. While thyroxine levels are important for thyroid function assessment, they do not directly reflect the functioning of the adrenal gland. Therefore, thyroxine levels are not relevant in diagnosing adrenal cortex failure.
Choice D reason: Insulin is a hormone produced by the pancreas and is essential for regulating blood glucose levels. It is not related to the adrenal cortex. Monitoring insulin levels is important for diagnosing and managing diabetes mellitus but does not provide information about the functioning of the adrenal gland. Insulin levels are not used to assess adrenal cortex function.

Choice A reason: Sputum is the most appropriate specimen to collect prior to the initiation of antibiotic therapy in a client with suspected pneumonia. Sputum cultures can help identify the specific bacteria or other pathogens causing the infection, allowing for targeted antibiotic therapy. Collecting the sputum sample before starting antibiotics ensures that the culture results are not influenced by the medication, leading to more accurate identification of the causative agent and more effective treatment.
Choice B reason: Urine is not the appropriate specimen to collect for diagnosing pneumonia. While urine cultures can be useful for diagnosing urinary tract infections or detecting certain pathogens through urine antigen tests, they are not relevant to identifying the etiology of a respiratory infection like pneumonia. The focus should be on obtaining samples directly from the respiratory system.
Choice C reason: A throat smear can be useful for diagnosing upper respiratory tract infections, such as strep throat, caused by Group A Streptococcus. However, it is not the most relevant test for diagnosing pneumonia, which affects the lower respiratory tract. A sputum sample is more appropriate for identifying the pathogens responsible for pneumonia.
Choice D reason: Blood cultures can be useful for detecting bacteremia or septicemia, especially in severe cases of pneumonia where the infection has spread to the bloodstream. However, they are not the primary method for identifying the specific cause of pneumonia. Blood cultures are typically used in conjunction with other tests, such as sputum cultures, to provide a comprehensive diagnosis.