A nurse is caring for a pediatric client who is receiving pancreatic enzyme replacement therapy. Which nursing action measures the effectiveness of the therapy?
Monitoring the stool consistency.
Checking the pupillary reflex response.
Listening to breath sounds.
Auscultating the apical pulse rate.
The Correct Answer is A
Choice A rationale:
Monitoring the stool consistency is a crucial nursing action to assess the effectiveness of pancreatic enzyme replacement therapy. Patients with pancreatic insufficiency, such as those with cystic fibrosis, may have difficulty digesting fats properly. Improved stool consistency, specifically a reduction in greasy and foul-smelling stools, indicates that the pancreatic enzymes are aiding in fat digestion.
Choice B rationale:
Pupillary reflex response assessment is unrelated to pancreatic enzyme replacement therapy. It is more commonly performed to assess neurological status or the effects of medications affecting the autonomic nervous system.
Choice C rationale:
Listening to breath sounds is important for assessing respiratory status, but it does not directly reflect the effectiveness of pancreatic enzyme replacement therapy.
Choice D rationale:
Auscultating the apical pulse rate is a general assessment of cardiovascular function and does not provide information about the effectiveness of pancreatic enzyme replacement therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
The identification band falling off the patient's leg is a documentation concern and doesn't require immediate action unless the patient is at risk of wandering or abduction.
Choice B rationale:
IV fluids should be changed every 24 hours to prevent bacterial growth and infection. Using fluids that are 48 hours old increases the risk of introducing infection to the patient.
Choice C rationale:
The crib rails being halfway up is not an immediate concern unless the child is at risk of falling or climbing out of the crib.
Choice D rationale:
Damp bed linen can be addressed during the next bedding change. It may not require immediate action unless the patient's skin integrity is at risk.
Correct Answer is C
Explanation
Choice A rationale:
Baclofen from an intrathecal pump primarily affects muscle tone and spasticity, not seizure medications .
Choice B rationale:
Baclofen use generally leads to a reduction in dystonia , not an increase. It's used to manage spasticity, not exacerbate it.
Choice C rationale:
The correct answer. Baclofen administered via an intrathecal pump is intended to reduce muscle tone and spasticity, improving mobility and comfort for patients with conditions like cerebral palsy.
Choice D rationale:
Baclofen doesn't typically cause decreased mobility . In fact, its use is expected to enhance mobility by reducing spasticity.
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