A home health nurse is planning her daily visits and receives laboratory results for four adult clients. The nurse should first visit the client who has which of the following laboratory values?
Digoxin 1.0 ng/mL.
WBC 6,000/mm³.
Platelets 100,000/mm³.
Serum potassium 4.0 mEq/L.
The Correct Answer is C
Choice A rationale:
Digoxin is a medication used to treat heart conditions like heart failure and atrial fibrillation. A digoxin level of 1.0 ng/mL is within the therapeutic range (usually 0.5-2.0 ng/mL), indicating that the client's digoxin dosage is appropriate. However, this value doesn't indicate an urgent need for a home visit.
Choice B rationale:
A white blood cell count (WBC) of 6,000/mm³ falls within the normal range (typically 4,500-11,000/mm³). While this value could suggest a stable immune system, it doesn't provide information requiring immediate attention or a home visit.
Choice C rationale:
Platelets are essential for blood clotting. A platelet count of 100,000/mm³ is significantly below the normal range (usually 150,000-450,000/mm³), indicating a risk of bleeding and potentially a serious medical condition. This client is at risk for spontaneous bleeding and requires prompt assessment and intervention, making this choice the correct answer.
Choice D rationale:
A serum potassium level of 4.0 mEq/L falls within the normal range (typically 3.5-5.0 mEq/L). While maintaining electrolyte balance is important, this potassium level doesn't indicate an immediate need for a home visit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Ethics committees are tasked with providing guidance and recommendations in ethical dilemmas. They don't make the final decisions, but rather facilitate discussions and help individuals involved in the situation to weigh the options and make informed choices. This is consistent with the committee's role in addressing complex ethical decisions.
Choice B rationale:
Providing a legal representative for the family is not the primary role of an ethics committee. Legal representation is a separate matter and might be considered in situations where there are legal implications, but the committee's primary function is to address ethical concerns and conflicts.
Choice C rationale:
While ethics committees can offer recommendations, their focus is not necessarily on determining the best course of action for the client. Instead, they help individuals explore ethical principles and values to make decisions that align with the client's best interests.
Choice D rationale:
The ethics committee does not make decisions on behalf of the nursing team. Its role is to provide guidance and promote ethical discussions. Deciding how the nursing team should resolve the dilemma is beyond the committee's scope.
Correct Answer is D
Explanation
Choice A rationale:
The National League for Nursing (NLN) focuses on nursing education standards and resources for nursing faculty. While it could provide useful insights, it's not the primary resource for policy creation related to procedures like catheter insertion.
Choice B rationale:
The American Academy of Nursing (AAN) is a professional organization that promotes leadership and education within nursing. While it might offer recommendations, it's not the primary resource for policy related to procedural changes in clinical settings.
Choice C rationale:
The Agency for Healthcare Research and Quality (AHRQ) is involved in research and quality improvement initiatives in healthcare. While it could provide evidence-based practices, it's not the primary source for policies specific to nursing procedures.
Choice D rationale:
The State Nurse Practice Act (NPA) outlines the scope of nursing practice within a particular state. It governs what nurses are allowed to do, including procedures like catheter insertion. The NPA ensures that nursing actions are within legal and regulatory bounds, making it the most relevant resource for creating a policy about catheter insertion.
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