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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. Consecutive evening serum glucose greater than 260 mg/dL.
Choice A rationale:
A consecutive evening serum glucose greater than 260 mg/dL indicates persistent hyperglycemia. Inadequate NPH insulin dosage may lead to consistently high blood glucose levels, which can result in various complications.
Choice B rationale:
The complaint of cold feet and numbness is not a specific indicator of inadequate insulin dosage. Neuropathy and circulation issues can occur with poorly controlled diabetes, but they are not solely indicative of inadequate insulin.
Choice C rationale:
Nausea in the morning, even with the ability to eat breakfast, does not necessarily point to inadequate insulin dosage. It could be due to various factors, including dietary choices or other medical conditions.
Choice D rationale:
The wound on the ankle that starts to drain and becomes painful is not a specific sign of inadequate insulin dosage. Poorly controlled diabetes can lead to delayed wound healing, but it does not necessarily indicate that the current insulin dosage is insufficient.
Correct Answer is D
Explanation
The correct answer is choice D: Provide fluid and electrolyte replacement. Choice A rationale:
Isolating all infectious diarrhea victims is not the highest priority in this situation. While it is essential to prevent the spread of cholera, immediate medical intervention to treat those affected takes precedence.
Choice B rationale:
Administering prophylactic antibiotics as prescribed is not the highest priority because it focuses on prevention rather than treatment. In the case of a cholera outbreak, it is more critical to address the immediate needs of those already diagnosed.
Choice C rationale:
Administering cholera vaccines may be part of a preventive strategy, but it is not the highest priority during an active cholera outbreak. Vaccination takes time to develop immunity, and the focus should be on treating those already affected.
Choice D rationale:
Providing fluid and electrolyte replacement is the highest priority in managing cholera. Cholera is characterized by severe diarrhea and dehydration, which can lead to life-threatening complications. Promptly restoring fluids and electrolytes helps prevent shock and organ failure.
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