A female patient is in intensive care recovering from a severe illness and has these laboratory results:
total white blood cells 2,000 cells/mm3, neutrophils 40%, lymphocytes 35%, monocytes 11%, eosinophils 4%, basophils 0%, red blood cell count 4.2 × 106 cells/mm3, hemoglobin 11.7 g/dL, hematocrit 38%, serum sodium 140 mEq/L, serum potassium 4.0 mEq/L. Based on the laboratory results, what is the highest-priority nursing action?
A) Monitor cardiac rhythm closely.
B) Measure intake and output carefully.
C) Institute protective isolation.
D) Obtain an order for antibiotic therapy.
C
You might also like to view...
The patient is admitted with severe abdominal pain due to pancreatitis. The patient asks the nurse, "What causes this? Why does it hurt so much?" The nurse should Answer:
a. "Pancreatitis is extremely rare and no one knows why it causes pain." b. "Pancreatitis is caused by diabetes; you should be checked." c. "Injury to certain cells in the pancreas causes it to digest (eat) itself, causing pain." d. "The pain is localized to the pancreas. Fortunately, it will not affect anything else."
The patient, who is a legal secretary, asks the nurse how she can avoid developing carpal tunnel syndrome. The nurse suggests:
a. exercising the wrist with repetitive flexion movements. b. wrapping the wrists with elastic bandages. c. acquiring a pad to support wrists while typing. d. applying warm compresses to wrists every evening.
A patient who was in a fight sustained several direct blows to the face. The nurse assesses an elevated pulse (P 108), elevated respiratory rate (RR 24), and obvious deformity to the right side of the face
What should the nurse identify as the priority of care for this patient? 1. frequently assessing the blood pressure for signs of shock and initiating IV fluids 2. monitoring the elevated respiratory rate and maintaining the airway 3. monitoring the elevated pulse rate and looking for signs of pallor 4. frequently assessing for facial pain and administering pain medication p.r.n.
A patient has given permission for an enzyme immunoassay (EIA) test for HIV. Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. "You will need to return to the clinic in 3 days to discuss the results of this test.". 2. "I will send you the results in the mail.". 3. "If the test is positive, we will immediately set up an appointment for you to receive medications to treat the HIV.". 4. "A Western blot test may also be necessary.". 5. "If the test is negative, it will be repeated.".