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Exhibits

Click to highlight the findings that indicate an improvement in the client’s condition

Laboratory Results

1800:

WBC count 6,700/mm3 (5,000 to 10,000/mm3)

Hemoglobin 12 g/dL (14 to 18 g/dL)

Hematocrit 36% (40% to 52%)

Vital Signs

1800:

Blood pressure 112/74 mm Hg

Heart rate 95/min

Respiratory rate 18

Temperature 37.5(99.5° F)

WBC count 6,700/mm3 (5,000 to 10,000/mm3)

Hemoglobin 12 g/dL (14 to 18 g/dL)

Hematocrit 36% (40% to 52%)

Blood pressure 112/74 mm Hg

Heart rate 95/min

Respiratory rate 18

Temperature 37.5(99.5° F)

Answer and Explanation

The Correct Answer is ["B","C","D","E"]

Rationale for correct choices:

Hemoglobin 12 g/dL: The increase from 9.1 g/dL to 12 g/dL indicates that the client’s anemia is resolving. This suggests effective treatment or stabilization following blood loss, improving oxygen-carrying capacity and overall perfusion.
Hematocrit 36%: The rise from 27% to 36% reflects an improvement in the proportion of red blood cells in circulation. This correlates with better tissue oxygenation and a positive response to interventions such as a blood transfusion.
Blood pressure 112/74 mm Hg: The increase from 90/50 mm Hg indicates improved hemodynamic stability. This suggests the client is no longer hypovolemic and is better able to maintain adequate perfusion to vital organs.
Heart rate 95/min: The decrease from 118/min shows a reduction in compensatory tachycardia. This reflects improved circulatory status and decreased physiological stress following stabilization of blood volume and oxygenation.

Rationale for incorrect choices:

WBC count 6,700/mm³: The WBC count remains unchanged from admission. While within normal limits, it does not specifically indicate improvement in anemia or hemodynamic status, which are the primary concerns in this scenario.
Respiratory rate 18/min: The respiratory rate is unchanged and within normal limits. Although stable, it does not provide a direct measure of improvement in anemia or perfusion.
Temperature 37.5°C (99.5°F): The temperature is stable but slightly elevated. While not concerning, it does not reflect a specific improvement in the client’s primary condition.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Clostridium difficile: C. difficile infections are typically managed within healthcare facilities and are not considered reportable to local health departments under standard public health reporting requirements.

B. Herpes simplex virus: HSV infections are common and usually not reportable to public health authorities, except in cases of neonatal herpes or unusual outbreaks, as routine cases are managed clinically.

C. Chlamydia trachomatis: Chlamydia is a sexually transmitted infection that is nationally notifiable. Reporting to the local health department is required to track incidence, prevent spread, and facilitate partner notification and treatment.

D. Human papilloma virus: HPV infections are widespread and typically not reportable because most cases are asymptomatic or self-limiting. Reporting is not required for routine surveillance or treatment purposes.

A. Give an antibiotic 30 min before dialysis. B. Check the vascular access site for bleeding after dialysis. C. Rehydrate with dextrose 5% in water for orthostatic hypotension. D. Withhold all medications until after dialysis.

Correct Answer is B

Explanation

A. Give an antibiotic 30 min before dialysis: Some antibiotics may require timing adjustments around dialysis, but this depends on the specific drug and provider orders. Administering antibiotics is not universally required before each dialysis session.

B. Check the vascular access site for bleeding after dialysis: Monitoring the vascular access site for bleeding, swelling, or infection is a critical safety measure after hemodialysis. Proper assessment helps prevent complications such as hemorrhage or thrombosis.

C. Rehydrate with dextrose 5% in water for orthostatic hypotension: Fluid administration during or after dialysis must be carefully managed due to the risk of fluid overload. Standard rehydration with dextrose 5% in water is not routinely recommended for hypotension after dialysis.

D. Withhold all medications until after dialysis: Not all medications should be withheld; some are given before or during dialysis depending on their pharmacokinetics and dialysis clearance. Blanket withholding of medications can be unsafe and may lead to untreated conditions.

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Naxlex Comprehensive Predictor Exams

A nurse in the infectious disease division of the local health department is caring for a client. Which of the following infections should the nurse identify should be reported to the health department?

Correct Answer is C

Explanation

A nurse is planning care for a client who is receiving hemodialysis. Which of the following actions should the nurse include in the plan of care?

Correct Answer is B

Explanation

A nurse is caring for a client who is postoperative immediately following a cardiac catheterization with a right femoral approach. Which of the following actions should the nurse take?

A home health nurse is teaching a new parent about caring for his 1-week-old infant. Which of the following statements by the client indicates an understanding of the teaching?

A nurse in the emergency department is caring for a client who has major burns. Which of the following actions should the nurse take?

A nurse is caring for a client in the emergency department. Exhibits Which of the following interventions should the nurse include in the plan of care? Select all that apply.

A nurse is completing an incident report after a client fall. Which of the following competencies of Quality and Safety Education for Nurses is the nurse demonstrating?

A nurse is teaching the parents of a 6-year-old child who has sickle cell anemia about managing the disease. The nurse should emphasize the importance of which of the following factors to prevent a sickle cell crisis?

A nurse in a mental health clinic receives a request from a client who is undergoing psychotherapy to obtain a copy of the therapist's notes. Which of the following responses should the nurse make?

A nurse is assessing the fontanels of an 8-month-old infant. Which of the following findings should the nurse recognize as an expected finding?