A nurse is caring for a female client who has toxic shock syndrome.

Which of the following findings should the nurse expect?

Elevated platelet count.

Decreased total bilirubin.

Hypertension.

Generalized rash.

Answer and Explanation

The Correct Answer is D

Toxic shock syndrome (TSS) is a life-threatening condition caused by bacterial toxins.
Common symptoms include high fever, low blood pressure, headache, rapid heartbeat, nausea and vomiting, muscle pain, malaise, confusion, and rashes on the soles and palms.
A generalized rash resembling a sunburn is one of the possible signs and symptoms of TSS.
A. Elevated platelet count: TSS does not cause an elevated platelet count.
B. Decreased total bilirubin: TSS does not cause a decrease in total bilirubin levels.
C. Hypertension: TSS causes low blood pressure (hypotension), not high blood pressure (hypertension).

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Correct Answer is D

Explanation

The nurse should plan to insert a large-bore nasogastric tube for a client who has upper gastrointestinal bleeding due to a peptic ulcer.

This allows for gastric lavage and can help diagnose the source of bleeding.
Choice A is wrong because a 22-gauge IV line may be too small for rapid fluid resuscitation.
Choice B is wrong because ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastrointestinal bleeding.
Choice C is wrong because nitroprusside is a vasodilator used to treat hypertensive emergencies and is not typically used for upper gastrointestinal bleeding.

A. Apply pressure to venipuncture sites for 10 min. B. Move the client to a negative pressure room. C. Instruct the client to avoid eating raw fruit. D. Use contact isolation while providing care.

Correct Answer is C

Explanation

Instruct the client to avoid eating raw fruit.
A low white blood cell count can be caused by cancer or cancer treatment and can increase the risk of infection.
One precaution that can be taken is to avoid all pre-cut fresh fruits and vegetables in delis, restaurants, and grocery stores.
Choice A Applying pressure to venipuncture sites for 10 min is not necessary for a low WBC count.
Choice B Moving the client to a negative pressure room is not necessary for a low WBC count.
Choice D Contact isolation while providing care is not necessary for a low WBC count.

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A nurse is caring for a female client who has toxic shock syndrome. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who has upper gastrointestinal bleeding due to a peptic ulcer. Which of the following actions should the nurse plan to take?

Correct Answer is D

Explanation

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Correct Answer is C

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A nurse is caring for a female client who has toxic shock syndrome.

Which of the following findings should the nurse expect?