A nurse in a clinic is assessing a 7-month-old infant. Which of the following indicates a need for further evaluation?

Choice A: A WBC count of 17,000/mm³ is an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates leukocytosis, which is an increase in white blood cells. Leukocytosis can occur in a child who has cystic fibrosis (CF), which is a condition that causes thick mucus to block the airways and lungs and causes respiratory infections and inflammation. A normal WBC count for children is 5,000 to 10,000/mm³.

Choice B: A neutrophil count of 3,000/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal neutrophil levels. Neutrophils are a type of white blood cell that fight bacterial infections. A normal neutrophil count for children is 1,500 to 8,000/mm³.

Choice C: A lymphocyte count of 3,000/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal lymphocyte levels. Lymphocytes are a type of white blood cell that fight viral infections. A normal lymphocyte count for children is 1,500 to 4,000/mm³.

Choice D: An RBC count of 4.2 million/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal red blood cell levels. Red blood cells carry oxygen and carbon dioxide throughout the body. A normal RBC count for children is 4 to 5.5 million/mm³.

Choice A:In actual practice, log rolling is typically done every 2 hoursto align with standard nursing protocols for preventing complications such as pressure injuries, maintaining skin integrity, and ensuring patient comfort. Repositioning every 2 hours also helps promote better circulation and reduces the risk of complications like pneumonia and deep vein thrombosis (DVT).
as a unit without twisting or bending the spine. The nurse should use a draw sheet and at least two other staff
members to assist with log rolling.

Choice B: This intervention is incorrect, as keeping the head of the bed at a 30-degree angle can cause flexion of the spine and compromise spinal alignment. The head of the bed should be kept flat or slightly elevated, depending on the provider's orders and the client's comfort. The nurse should avoid raising or lowering the head of the bed without checking with the provider first.

Choice C: This intervention is unnecessary, as placing the client in protective isolation is not indicated for a client who is postoperative following scoliosis repair with Harrington rod instrumentation. Protective isolation is used for clients who have compromised immune systems and are at high risk of acquiring infections from others, such as transplant recipients, cancer patients, or patients receiving immunosuppressive therapy. The nurse should follow standard precautions and surgical site care to prevent infection in this client.

Choice D: This intervention is optional, as initiating the use of a PCA pump for pain control may or may not be appropriate for a client who is postoperative following scoliosis repair with Harrington rod instrumentation. A PCA pump is a device that allows the client to self-administer a preset dose of analgesic medication by pressing a button. A PCA pump can provide effective and individualized pain relief, but it requires careful monitoring and education. The nurse should assess the client's pain level, preference, and ability to use a PCA pump and consult with the provider before initiating it.