The practical nurse (PN) is caring for a client with pyelonephritis who is admitted for parenteral anti-infective therapy. Prior to discharge home with an oral medication regimen, which instruction is most important for the practical nurse (PN) to reinforce with the client?

Choice A reason: Nausea is a common side effect of chemotherapy and can significantly affect the client's quality of life. Managing nausea is important for ensuring the client can maintain adequate nutrition and hydration. However, it is not the most critical problem when planning care for a client with leukemia, as it does not pose an immediate threat to life compared to the risk of infection.
Choice B reason: Fatigue is another common issue experienced by clients undergoing chemotherapy. It can result from the treatment itself, the underlying disease, or anemia. While addressing fatigue is essential for improving the client's daily functioning and well-being, it is not the most urgent concern in this scenario. The client's significantly low WBC count poses a more immediate risk to their health.
Choice C reason: Infection is the most significant problem to consider when planning care for this client. The client's WBC count of 2,500/mm³ (2.5 x 10⁹/L) is well below the normal range, indicating leukopenia, which increases their susceptibility to infections. Clients with leukemia receiving chemotherapy are at a higher risk for infections due to both the disease and the treatment's impact on the immune system. Monitoring for signs of infection, implementing infection control measures, and providing prompt treatment if an infection is detected are critical to prevent severe complications.
Choice D reason: Bleeding is a potential concern for clients with leukemia, especially if platelet counts are low. However, in this case, the client's platelet count is within the normal range (250,000/mm³ or 250 x 10⁹/L). While it is important to monitor for bleeding, the immediate risk of infection due to the low WBC count is more pressing and requires prioritized attention.

Choice A reason: Flushed, hot skin is not directly related to the client's CBC results. This symptom can indicate various conditions, such as fever, inflammation, or an allergic reaction, but it does not specifically correlate with the lab findings provided. The client's WBC count, hemoglobin, hematocrit, and basophils are within normal ranges, and the most significant abnormality is the low platelet count.
Choice B reason: Hives, or urticaria, are typically associated with allergic reactions and not directly related to the client's CBC results. While a low platelet count can sometimes be associated with immune-mediated conditions, hives are not a primary symptom of thrombocytopenia (low platelet count). The main concern with a low platelet count is the increased risk of bleeding and bruising.
Choice C reason: Inelastic turgor is a sign of dehydration or poor skin elasticity, often seen in conditions such as severe dehydration or malnutrition. The client's CBC results do not indicate dehydration or issues with skin turgor. The hemoglobin and hematocrit levels are within normal ranges, suggesting that the client's overall fluid status is likely stable.
Choice D reason: Bruising is the most relevant finding to assess for in a client with a low platelet count (thrombocytopenia). Platelets play a crucial role in blood clotting, and a low platelet count increases the risk of bleeding and easy bruising. The client's platelet count of 98,000/mm³ (98 x 10⁹/L) is below the normal range, which predisposes them to bruising and potential bleeding complications. It is important for the practical nurse to assess for signs of bruising and bleeding and to monitor the client closely for any further complications.