Question

A nurse admits a client who has anorexia, low-grade fever, night sweats, and productive cough. Which of the following actions should the nurse take first?

A. Administer an antipyretic
B. Obtain a sputum culture
C. Assess lung sounds
D. Provide a high-calorie diet

Answer 1

The nurse's first action should be to assess the patient's lung sounds to determine their respiratory status, which is essential before proceeding with other interventions like obtaining a sputum culture or administering medications.

Step-by-step explanation:

When a nurse admits a client with symptoms indicative of a potential infection, such as anorexia, low-grade fever, night sweats, and productive cough, the priority is to determine the cause of these symptoms. The first action should be C. Assess lung sounds. This will provide immediate information on the patient's respiratory status and identify any abnormal sounds that may indicate a respiratory infection or other pulmonary conditions. Establishing baseline respiratory assessment is crucial before further interventions, such as obtaining a sputum culture or administering medications, can be appropriately planned. Once the nurse has assessed the lung sounds and identified potential abnormalities, obtaining a sputum culture (B) would be an important next step to diagnose the specific pathogen causing the infection.