The practical nurse (PN) is caring for an older client who is receiving chemotherapy for lung cancer. Which finding is the highest priority for the PN to report to the charge nurse?

Reference ranges:

Blood urea nitrogen (BUN): [Adult: 10 to 20 mg/dL or 3.6 to 7.1 mmol/L] Platelets: [150,000 to 400,000/mm3 or 150 to 400 x 10^9/L]

Periodic nausea and vomiting.

Decreased deep tendon reﬂexes.

Platelet count 135,000/mm3 or 135 x 10^9/L

Blood urea nitrogen 75 mg/dL or 12.9 mmol/L

Answer and Explanation

The Correct Answer is D

A high blood urea nitrogen (BUN) level indicates impaired renal function, which can be caused by dehydration, infection, or nephrotoxic drugs. Chemotherapy can damage the kidneys and increase the risk of renal failure. The PN should report this finding to the charge nurse, as it may require ﬂuid replacement, dose adjustment, or discontinuation of the chemotherapy.

The other options are not correct because:

A. Periodic nausea and vomiting are common side eﬀects of chemotherapy that can be managed with antiemetics, hydration, and dietary modifications. They are not as urgent as a high BUN level.

B. Decreased deep tendon reﬂexes may indicate hypocalcemia, hypomagnesemia, or peripheral neuropathy, which can be caused by chemotherapy or other factors. They are not as urgent as a high BUN level.

C. A platelet count of 135,000/mm3 or 135 x 10^9/L is slightly below the normal range, but not significantly low. Chemotherapy can cause thrombocytopenia, which increases the risk of bleeding. The PN should monitor the client for signs of bleeding, but this finding is not as urgent as a high BUN level.

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Correct Answer is A

Explanation

This is the most important follow-up assessment for the PN to implement because it can detect signs of bleeding, infection, or shock that may result from the unsecured surgical dressing. The PN should monitor the client's blood pressure, pulse, temperature, and respiratory rate and report any abnormal changes.

A. Explain that the healthcare provider probably prescribed a different medication while he is hospitalized. B. Tell the client that the PN will verify that the dispensed medication is the valid prescription. C. Explain that the pharmacy often substitutes generic equivalents for more expensive brands. D. Tell the client that he is probably confused since being hospitalized tends to disorient clients.

Correct Answer is B

Explanation

Tell the client that the PN will verify that the dispensed medication is the valid prescription. Choice A rationale:

Explaining that the healthcare provider probably prescribed a different medication while the client is hospitalized (Choice A) may create confusion or concern for the client. It is essential to reassure the client and take appropriate action to address the discrepancy in the appearance of the medication.

Choice C rationale:

Explaining that the pharmacy often substitutes generic equivalents for more expensive brands (Choice C) is not applicable in this situation since the client is expressing concern about the appearance of the medication prescribed by the healthcare provider, not a substitution by the pharmacy.

Choice D rationale:

Telling the client that he is probably confused since being hospitalized tends to disorient clients (Choice D) is dismissive of the client's concerns. It is crucial to acknowledge the client's observation and address the issue professionally.

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Naxlex Comprehensive Predictor Exams

The practical nurse (PN) finds a postoperative client lying in bed with an unsecured surgical dressing as seen in the picture. After reinforcing the dressing, which follow-up assessment is most important for the PN to implement?

Correct Answer is A

Explanation

A male client tells the practical nurse (PN) that the pill he has been taking at home is a different color and size than the one the PN is trying to give him now. How should the PN respond?

Correct Answer is B

Explanation

While receiving report for a client with carcinoma in situ of the left breast, the practical nurse (PN) reviews a pending lab report and notices the client's Absolute Neutrophil Count (ANC) has decreased. Which changes should the PN anticipate to be included in the client's plan of care?

The practical nurse (PN) is assessing an older client with left-sided heart failure (HF). What intervention is most important for the PN to implement?

What is most important for the practical nurse (PN) to include when performing pain assessment after giving an analgesic?

When performing a focused gastrointestinal system assessment, the practical nurse (PN) asks a male client when his last bowel movement occurred. The client answers, "Three days ago.”. Which action should the PN implement first?

On the first day after a cesarean section, a client who is a primipara is being assisted to the bathroom for the first time. The client experiences a sudden gush of vaginal blood and notices that several blood clots are in the toilet. Which action should the practical nurse (PN) take?

When the practical nurse (PN) attempts to assist an 18-year-old client with a mild mental disability to ambulate on the first postoperative day after an appendectomy, she becomes angry and yells at the PN, "Get out of here! I'll get up when I'm ready!”. Which response isbest for the PN to make?

In caring for a client who requires seizure precautions, the practical nurse (PN) should ensure the ready availability of equipment to perform which procedure?

The practical nurse (PN) is assisting with preparation of a client for fecal diversion surgery. While inserting an indwelling urinary catheter, the client asks if the surgical opening will be visible. Which action should the PN implement?