A nurse is collecting data from a client who is receiving vancomycin for a Clostridium difficile infection.
Which of the following findings is the priority for the nurse to report to the provider?
Two loose stools in the past 24 hr.
WBC 11,000/mm³.
Heart rate 104/min.
Creatinine 3.1 mg/dL.
The Correct Answer is D
Choice A rationale:
Two loose stools in the past 24 hours could be a symptom of Clostridioides difficile infection, but it’s not necessarily a priority finding. The infection can cause diarrhea, but it’s not life-threatening.
Choice B rationale:
A WBC count of 11,000/mm³ is slightly elevated, indicating a possible infection. However, it’s not necessarily a priority finding as it’s not significantly high.
Choice C rationale:
A heart rate of 104/min is slightly elevated, indicating possible stress or anxiety. However, it’s not necessarily a priority finding as it’s not significantly high.
Choice D rationale:
Creatinine level of 3.1 mg/dL is significantly high, indicating possible kidney damage, which can be a side effect of vancomycin treatment. This should be reported to the provider immediately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
AST (Aspartate Aminotransferase) is a liver enzyme and its levels are used to assess liver function, not the effectiveness of epoetin alfa.
Choice B rationale:
Troponin is a cardiac marker used to diagnose heart attacks. It has no relation with the effectiveness of epoetin alfa.
Choice C rationale:
T4 (Thyroxine) is a thyroid hormone. Its levels indicate thyroid function, not the effectiveness of epoetin alfa.
Choice D rationale:
Hgb (Hemoglobin) levels are used to assess the effectiveness of epoetin alfa. Epoetin alfa is a medication that stimulates the production of red blood cells, thereby increasing hemoglobin levels in the blood. Normal hemoglobin levels are 13.5 to 17.5 g/dL in men and 12.0 to 15.5 g/dL in women.
Correct Answer is D
Explanation
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