A nurse in an urgent care clinic is caring for a client who reports recently using methylenedioxy-methamphetamine. Which of the following findings should the nurse expect?

b. A decreased level of consciousness and vomiting

Explanation:

When receiving report on four clients, the nurse should first collect data about the client who has a decreased level of consciousness and vomiting. This combination of symptoms suggests a potentially serious condition that requires immediate atention and assessment. It could indicate a neurological or gastrointestinal issue, and further evaluation is necessary to determine the underlying cause and provide appropriate interventions.

Explanation for the other options:

a. Cellulitis accompanied by a low-grade fever:

While cellulitis and a low-grade fever require atention, they are not as immediately critical as a decreased level of consciousness and vomiting. The nurse should prioritize assessing the client with altered consciousness and vomiting due to the potential for more urgent interventions.

c. A pain rating of 7 on a scale from 0 to 10 after receiving analgesia 30 min ago:

Although the client's pain rating of 7 indicates ongoing pain, it is not as immediately critical as a decreased level of consciousness and vomiting. The nurse should first address the client with altered consciousness to determine the cause and provide appropriate interventions before assessing and managing pain in other clients.

d. Type 2 diabetes mellitus and a blood glucose level of 160 mg/dL:

While elevated blood glucose levels in a client with type 2 diabetes require atention and management, they are not as immediately critical as a decreased level of consciousness and vomiting. The nurse should first assess the client with altered consciousness to identify the cause and provide prompt interventions.

In summary, when receiving report on four clients, the nurse should first collect data about the client who has a decreased level of consciousness and vomiting. These symptoms indicate a potentially serious condition requiring immediate assessment and intervention.

Answer: A. Potassium

Rationale:

A) Potassium:

Furosemide is a loop diuretic that can cause significant potassium loss through increased urine output. Monitoring potassium levels is crucial to prevent hypokalemia, which can lead to serious cardiac arrhythmias and muscle weakness. Ensuring potassium levels remain within a normal range helps maintain the infant's overall health and safety while on this medication.

B) WBC Count:

While it is important to monitor WBC count in various clinical situations, furosemide does not typically affect white blood cell levels. Therefore, monitoring WBC count is not specifically indicated for infants receiving furosemide unless there is another underlying condition that requires it.

C) Iron:

Iron levels are not typically affected by furosemide. Monitoring iron levels would be more relevant in cases of anemia or other hematologic conditions. Furosemide does not interfere with iron metabolism, so this test is not a priority for infants on this medication.

D) Amylase:

Amylase is an enzyme related to the pancreas and is typically monitored in conditions such as pancreatitis. Furosemide does not have a direct effect on amylase levels, so monitoring this enzyme is not necessary for infants receiving this diuretic. The focus should be on electrolytes, particularly potassium.