Which of the following findings indicate a potential complication that requires immediate follow-up? (Select All that Apply.)
Neurological assessment
Basic metabolic panel
Blood pressure/heart rate
Abdominal assessment
Complete blood count
Pain assessment
Correct Answer : A,B,C,E,F
A. Neurological assessment is critical in identifying potential complications, especially in cases of head injury, infection, or brain-related conditions. A change in mental status or neurological findings (e.g., confusion, loss of consciousness) warrants immediate follow-up.
B. Basic metabolic panel provides key information on electrolyte imbalances, kidney function, and acid-base status. Imbalances or abnormalities, such as hyperkalemia or hyponatremia, can indicate life-threatening conditions.
C. Blood pressure/heart rate is crucial to monitor because abnormalities in these vital signs can indicate cardiovascular instability, shock, or autonomic dysfunction. Significant changes require immediate intervention.
D. Abdominal assessment is important but not always immediately urgent unless signs of acute abdominal issues (e.g., severe pain, distention, or bleeding) are present.
E. Complete blood count is essential for monitoring for signs of infection, anemia, or bleeding disorders. Abnormalities such as low hemoglobin or a high white blood cell count require further investigation.
F. Pain assessment is important but may not always indicate an immediate life-threatening issue. However, uncontrolled pain or new-onset severe pain can signal a complication, such as infection or tissue damage, which needs prompt attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Chest X-ray is not a definitive diagnostic test for leukemia. It is more commonly used to evaluate for signs of infection, lung abnormalities, or metastasis in cancer patients, but it does not confirm leukemia.
B. Urinalysis is not the definitive test for leukemia. While it may help assess kidney function or rule out other conditions, it is not used to diagnose leukemia.
C. Complete blood count (CBC) is useful for detecting abnormalities that may suggest leukemia, such as abnormal white blood cell counts, but it alone cannot definitively diagnose leukemia. It is typically part of the initial evaluation.
D. Bone marrow biopsy and aspiration is the definitive diagnostic test for leukemia. This test allows for direct examination of the bone marrow to confirm the presence of leukemia cells, making it the gold standard for diagnosis.
Correct Answer is B
Explanation
A. Has your child had a fever? While fever can be associated with febrile seizures, it is not a question used to screen for epilepsy. Febrile seizures are typically isolated events in young children and are not considered part of chronic epilepsy.
B. Did your child have an aura prior to a seizure? This is an important question for assessing epilepsy, especially focal seizures, as many individuals with epilepsy experience an aura (a warning sign) before a seizure. The presence or absence of an aura helps in classifying the type of seizure and can be useful in diagnosis.
C. Has your child had two or more seizures, in the last 1 year? This is not a screening question for epilepsy, but it would be relevant if epilepsy has already been diagnosed. Two or more seizures within a year can indicate a seizure disorder, but asking if the child has had multiple seizures would be more appropriate once epilepsy is suspected.
D. How long did your child's seizure last? The duration of a seizure is important to note during an episode, but it is not a question used during initial screening. The nurse would focus more on whether seizures occur, how they manifest, and if there are any warning signs (like an aura) prior to the event.
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