A nurse is assisting with the care of client in a clinic.

Based on the information in the client's medical record, which of the following findings require immediate follow-up? Select the 4 findings that require immediate follow-up by the nurse.

Rationale for correct choices:

• A Mantoux test: The client presents with a chronic productive cough, night sweats, low-grade fever, hemoptysis, recent weight loss, and recent travel to South Africa, which is a region with higher tuberculosis prevalence. A Mantoux test helps screen for Mycobacterium tuberculosis infection. These systemic and respiratory findings strongly support the need for TB evaluation.

• A chest xray: A chest xray is essential for evaluating pulmonary pathology when tuberculosis is suspected. It can reveal cavitary lesions, infiltrates, or consolidation consistent with active TB disease. Imaging is necessary to assess disease severity and guide further diagnostic testing and isolation precautions.

Rationale for incorrect choices:

• Blood cultures: Blood cultures are primarily used to identify systemic bloodstream infections or sepsis. This client’s presentation is localized to the respiratory system without signs of hemodynamic instability or systemic bacterial infection. Blood cultures would not be a priority for initial TB evaluation.

• A pulmonary function test: Pulmonary function tests assess chronic airflow or restrictive lung diseases such as asthma or COPD. They are not appropriate in the acute evaluation of suspected infectious diseases like tuberculosis. Performing PFTs would not help identify the cause of hemoptysis or constitutional symptoms.

• A nasopharyngeal swab: Nasopharyngeal swabs are used to detect viral respiratory infections such as influenza or COVID-19. The client’s prolonged symptoms, weight loss, night sweats, and hemoptysis are not consistent with an acute viral illness. TB evaluation requires targeted testing rather than upper airway swabs.

A. Moderate lochia rubra on the pad: Moderate lochia 24 hours postpartum is considered a normal finding as the uterus continues to shed the lining. It typically appears bright red and gradually decreases over the following days, so it does not require immediate reporting.

B. Nipple tenderness with breastfeeding: Nipple tenderness is common in the early postpartum period due to breastfeeding, especially if the latch is not optimal. While it should be addressed to prevent complications, it is not an urgent finding requiring immediate reporting.

C. Hemorrhoids on the rectal area: Hemorrhoids are a frequent postpartum occurrence, often resulting from vaginal delivery or straining during labor. They are uncomfortable but not emergent, so they do not need immediate reporting.

D. Calf edematous and tender: A calf that is swollen, edematous, and tender may indicate a deep vein thrombosis (DVT), which is a potentially life-threatening postpartum complication. This finding requires immediate reporting to the primary RN for timely assessment and intervention.