A nurse is caring for a school-age child who is taking valproic acid. The nurse should expect the provider to order which of the following diagnostic tests?
ABGs
Serum liver enzyme levels
Chest X-ray
Urine culture and sensitivity
The Correct Answer is B
Rationale:
A. Arterial blood gases (ABGs) are typically used to assess respiratory function and acid-base balance, which are not primary concerns with valproic acid use.
B. Serum liver enzyme levels are critical to monitor due to the risk of hepatotoxicity associated with valproic acid therapy, making this test essential for safe management.
C. A chest X-ray is generally used to assess respiratory conditions, not relevant for monitoring the effects of valproic acid.
D. Urine culture and sensitivity are used to diagnose urinary tract infections and are not relevant to the monitoring of valproic acid therapy.
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Correct Answer is D
Explanation
Rationale:
A. Decreased heart rate is not typical; children with Kawasaki disease often experience tachycardia.
B. Peeling of the soles of the feet is more commonly observed in the convalescent phase of Kawasaki disease rather than the acute phase.
C. Pain in weight-bearing joints can occur in Kawasaki disease but is not the hallmark symptom during the acute phase.
D. Fever unresponsive to antipyretics is a classic finding in the acute phase of Kawasaki disease, indicating ongoing inflammation and a need for further intervention.
Correct Answer is A
Explanation
Rationale:
A. Making a referral for social services is appropriate as they can assist the client with discharge planning, home care services, and resources for palliative care to support the client's wishes.
B. While it is important to explain the risks of leaving against medical advice, the priority is to support the client’s desire to go home, rather than focusing on the potential consequences at this moment.
C. Contacting the facility chaplain could be beneficial for emotional support, but it does not address the immediate need for facilitating the client’s wish to go home.
D. Encouraging the client to continue with inpatient care contradicts their expressed desire to be with family, which is a crucial aspect of their emotional well-being in this situation.