While changing a client's postoperative dressing, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?
Hematocrit.
Platelet count.
Creatinine level.
White blood cell (WBC) count.
The Correct Answer is D
The presence of purulent drainage at the wound indicates a potential infection, and monitoring the client's WBC count is an important laboratory value to assess for signs of infection. An elevated WBC count, specifically an increase in the neutrophil count (neutrophilia), can indicate an active infection and provide important information for the healthcare provider when evaluating the wound.
While hematocrit, platelet count, and creatinine level are essential laboratory values to assess the client's overall condition, they may not provide specific information regarding the presence of infection or purulent drainage at the wound site.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
It is important to determine if the client has any plans or intentions to act upon the voices' instructions. This information helps gauge the level of risk and guides further interventions and safety measures.
While the other questions may also be important to ask during the assessment, determining if the client believes the voices are real and when the voices began can provide valuable information about the client's perception and the duration of the symptoms. Asking about the use of hallucinogens is relevant to identify potential substance-induced causes of the hallucinations. However, assessing the client's intent and potential for harm is the priority in this situation.
Correct Answer is C
Explanation
The correct answer is: C. Experiences facial swelling after eating crab.
Choice A Reason: Drinking a glass of water in the past 2 hours is not typically a concern unless the patient has been instructed to fast. For most cardiac catheterization procedures, patients are asked to fast for a certain period before the procedure to reduce the risk of aspiration. However, small sips of water may be allowed with medications.
Choice B Reason: While reports of left chest wall pain are clinically significant and warrant investigation, they are not as immediately concerning for the angioplasty procedure itself. Chest pain is a symptom that may have led to the decision to perform angioplasty but does not pose an immediate risk of complication during the procedure as an allergy might.
Choice C Reason: As previously mentioned, experiencing facial swelling after eating crab is indicative of a shellfish allergy. This is important because the contrast dye used in angioplasty may contain iodine, and patients with shellfish allergies could have an increased risk of an allergic reaction to the iodine in the dye. It is essential to explore this further to take necessary precautions, such as premedication with antihistamines or using a different contrast agent.
Choice D Reason: Verbalizing a fear of being in a confined space, or claustrophobia, is a psychological concern that should be addressed to ensure the patient’s comfort during the procedure. However, it does not pose a direct risk to the safety of the angioplasty procedure like an allergic reaction does. Managing patient anxiety is important, but it is not the most critical factor to explore prior to the procedure.
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