Exhibits
Which laboratory tests would be helpful in determining the plan of care for this client? Select all that apply.
Coagulation studies
Type and screen
Urine osmolality
Complete blood count
Blood culture
Lipid panel
Arterial blood gas
Electrolytes
Correct Answer : A,B,D,G,H
A. Coagulation Studies: This client has liver and spleen lacerations with blood noted in the peritoneum, increasing the risk of coagulopathy due to active bleeding. The liver is responsible for producing clotting factors, and an injury may impair coagulation. The client also has a low hemoglobin (9.3 g/dL) and hematocrit (30%), suggesting ongoing blood loss. Monitoring prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) can guide transfusion therapy (e.g., fresh frozen plasma or platelets).
B. Type and Screen: This client has evidence of hemorrhagic shock (tachycardia, narrow pulse pressure, low hemoglobin/hematocrit) and may require blood transfusion. Type and screen determines ABO blood type and Rh factor to ensure availability of compatible blood products. If bleeding worsens, crossmatching blood would be necessary for transfusion.
C. Urine osmolality: Not a priority in this trauma case. Urine osmolality assesses kidney function and hydration status but does not provide urgent information about blood loss, shock, or ventilation status.
D. Complete Blood Count (CBC): Provides serial hemoglobin and hematocrit (H&H) monitoring to assess for ongoing internal bleeding. White blood cell (WBC) count helps detect infection or inflammation post-operatively. Platelets are critical for clotting and must be monitored, especially in trauma patients at risk for coagulopathy.
E. Blood culture: Used to detect bloodstream infections (sepsis), which is not an immediate concern in this trauma patient. While infection risk is relevant postoperatively, it is not a priority test for acute trauma care.
F. Lipid panel: Lipid panels evaluate cholesterol and triglyceride levels, which are irrelevant in acute trauma management.
G. Arterial Blood Gas (ABG): This client is intubated and ventilated, making ABG analysis essential for evaluating: Oxygenation (PaO₂, SaO₂) and ventilation (PaCO₂), Acid-base balance (pH, bicarbonate levels). Early detection of metabolic acidosis, which may indicate shock or inadequate perfusion.
H. Electrolytes: Trauma and fluid resuscitation can cause electrolyte imbalances, leading to cardiac arrhythmias, fluid shifts, and metabolic disturbances. Potassium (K⁺) is Essential to monitor due to IV fluids with potassium chloride infusion. Sodium (Na⁺), chloride (Cl⁻), and bicarbonate (HCO₃⁻) are crucial in assessing fluid status and acid-base balance. Lactate levels (part of a metabolic panel) can indicate tissue hypoxia and worsening shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Analyze past hurts and resentments to identify the source. This strategy is more appropriate for clients in therapy to address past trauma. It is not the immediate focus for managing anxiety.
B. Concentrate on and ventilate emotions when distressed. While expressing emotions is important, it might not be the most effective strategy for generalized anxiety disorder, as it can sometimes exacerbate anxiety.
C. Focus on small achievable tasks, not taxing problems. This approach helps the client manage anxiety by breaking down large tasks into manageable steps, which reduces the overwhelming feelings associated with generalized anxiety disorder.
D. Relax and reduce the amount of effort to solve the problem. Relaxation is useful, but focusing on small, achievable tasks is a more effective way to manage anxiety in this scenario.
Correct Answer is C
Explanation
A. Obtain additional consent for administration of Type A negative blood. This is not necessary, as the patient is being given a blood type compatible with their Rh factor.
B. Recheck the client's hemoglobin, blood type, and Rh factor. These values have already been determined and do not require rechecking unless there is a specific concern.
C. Transfuse Type A negative blood until Type AB negative is available. In an emergency, it is acceptable to transfuse Type A negative blood to an AB negative patient as the Rh factor is the same, and the A antigen in the blood is not an immediate issue in this context.
D. Administer normal saline solution until Type AB negative is available. While normal saline can be used to support blood volume, the priority is to correct the patient's severe anemia with blood transfusion.
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