A nurse is caring for a client who is at 14 weeks of gestation. Which of the following statements should the nurse identify as the client being emotionally prepared for pregnancy?

A chest x-ray is an essential diagnostic tool for evaluating a client with symptoms such as a productive cough, blood-tinged sputum, weight loss, night sweats, and a low-grade fever. These findings raise suspicion for tuberculosis (TB), particularly given the client’s recent travel to South Africa, where TB is more prevalent. A chest x-ray can help identify characteristic abnormalities such as upper lobe infiltrates, cavitations, or pleural effusions that are consistent with pulmonary TB.

A nasopharyngeal swab is primarily used to detect viral respiratory infections, such as influenza or COVID-19. While the client presents with a cough and fever, the chronic nature of symptoms and presence of hemoptysis make a viral infection less likely. Furthermore, viral infections typically present with acute onset symptoms rather than a prolonged illness with weight loss and night sweats.

Blood cultures are used to identify systemic bacterial infections, such as bacteremia or sepsis. Although the client has a fever, there are no indications of severe systemic infection, such as hypotension or signs of shock, making blood cultures a lower priority in this case.

A pulmonary function test evaluates lung function in conditions such as asthma or chronic obstructive pulmonary disease (COPD). The client has no history of these conditions, and their primary complaint involves symptoms suggestive of an infectious process rather than an obstructive pulmonary disease. Pulmonary function testing is not indicated for diagnosing TB or other respiratory infections.

A Mantoux test (tuberculin skin test) is a key diagnostic tool in assessing tuberculosis exposure. Given the client’s symptoms and travel history, this test helps determine prior exposure to Mycobacterium tuberculosis and the likelihood of latent or active infection. A positive test would support further diagnostic testing, such as sputum cultures, to confirm active TB disease.

A. Increased urinary output. Furosemide is a loop diuretic that promotes diuresis by inhibiting sodium and water reabsorption in the kidneys. Increased urinary output indicates the medication is effectively reducing fluid volume, which is beneficial for clients with heart failure to decrease edema and pulmonary congestion.
B. Decreased BUN level. Blood urea nitrogen (BUN) levels can fluctuate due to hydration status and kidney function, but a decrease in BUN is not a primary indicator of furosemide’s effectiveness. Instead, BUN levels should be monitored for potential elevation, which could indicate dehydration or renal impairment as an adverse effect of the medication.
C. Decreased hemoglobin level. Furosemide does not directly affect hemoglobin levels. A decrease in hemoglobin may indicate anemia, which is not a desired or expected effect of diuretic therapy for heart failure.
D. Increased weight of 0.91 kg (2 lb). An increase in weight suggests fluid retention, which would indicate that heart failure is worsening rather than improving. Effective furosemide therapy should lead to weight reduction due to fluid loss, not weight gain.