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Author Question: During the assessment of a client, the nurse notes large, solid, formed muscles of both upper and ... (Read 31 times)

Jramos095

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During the assessment of a client, the nurse notes large, solid, formed muscles of both upper and lower extremities. Which of the following does this finding suggest to the nurse?
 
  1. Sedentary lifestyle, limited activity
   2. Weak and limited abilities
   3. Active lifestyle, exercises regularly
   4. Questionable use of steroids

Question 2

A child is being treated for acute lymphocytic leukemia (ALL). The laboratory report shows a white blood cell count of 7,000/mm3. The nursing care plan would include which of the following nursing diagnosis as a priority for this client?
 
  1. Activity Intolerance
   2. Risk for Infection
   3. Impaired Gas Exchange
   4. Readiness for Enhanced Immunization Status



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yasmin

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Answer to Question 1

3. Active lifestyle, exercises regularly

Rationale:
The presence of large, solid, formed muscles of both upper and lower extremities suggest that the client is active and exercises regularly. This type of muscle mass would not be seen in a client with a sedentary lifestyle. This level of muscle mass would not be seen in a client who is weak. This level of muscle mass would not suggest limited activity or limited ability. There is not enough information to support the idea that the client is using steroids to develop muscle mass.

Answer to Question 2

2. Risk for Infection

Rationale:
In leukemia, the WBC's that are present are immature and incapable of fighting infection. The client may or may not have activity intolerance, but it is not the priority nursing diagnosis. Impaired gas exchange is not evident in this client. Children with cancer would not be receiving immunizations during treatment.



Jramos095

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Both answers were spot on, thank you once again



yasmin

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