A client with Parkinson’s disease (PD) is being discharged home with his wife. To ensure success with the management plan, which discharge action is most effective?

Telling his wife what the client needs.

Setting up visitations by a home health nurse.

Involving the client and his wife in developing a plan of care.

Writing up a detailed plan of care according to standards.

Answer and Explanation

The Correct Answer is C

Choice A Reason:

Telling his wife what the client needs is not the most effective discharge action. While it is important for the wife to understand the client’s needs, this approach is too passive and does not actively engage the client or his wife in the care process. Effective management of Parkinson’s disease requires active participation from both the client and the caregiver to ensure adherence to the care plan and to address any concerns or preferences they may have.

Choice B Reason:

Setting up visitations by a home health nurse can be beneficial, but it is not the most effective discharge action on its own. Home health nurses can provide valuable support and monitoring, but the success of the management plan also depends on the involvement and commitment of the client and his wife. Without their active participation, the care plan may not be fully effective.

Choice C Reason:

Involving the client and his wife in developing a plan of care is the most effective discharge action. This approach ensures that both the client and his wife are fully engaged in the care process, understand the management plan, and are more likely to adhere to it. Collaborative care planning allows for the consideration of the client’s and caregiver’s preferences, needs, and concerns, leading to a more personalized and effective care plan. This active involvement can also empower the client and his wife, improving their confidence in managing the disease.

Choice D Reason:

Writing up a detailed plan of care according to standards is important, but it is not the most effective discharge action if done in isolation. A standardized care plan may not address the unique needs and preferences of the client and his wife. Without their involvement in the development of the plan, there may be a lack of understanding or commitment to the care plan, reducing its effectiveness. Personalizing the care plan through active involvement of the client and his wife is crucial for successful management.

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Correct Answer is A

Explanation

Choice A Reason:

Continuing to monitor is the most appropriate action in this scenario. The patient has a regular heart rhythm and a heart rate of 60 beats per minute, which is within the normal range for sinus bradycardia. The PR interval is 0.20 seconds, which is at the upper limit of normal. The patient’s vital signs are stable, with a blood pressure of 118/68 mm Hg, a respiratory rate of 16 breaths per minute, and a temperature of 98.8°F (37°C). There are no signs of hemodynamic instability or symptoms that would necessitate immediate intervention. Therefore, ongoing monitoring is sufficient to ensure the patient’s condition remains stable.

Choice B Reason:

Administering clonidine is not appropriate in this situation. Clonidine is an antihypertensive medication that can lower blood pressure and heart rate. Given that the patient’s blood pressure and heart rate are within normal ranges, administering clonidine could potentially cause hypotension and bradycardia, leading to adverse effects. Therefore, clonidine is not indicated for this patient.

Choice C Reason:

Administering atropine is not necessary for this patient. Atropine is used to treat symptomatic bradycardia, where the heart rate is abnormally slow and causing symptoms such as dizziness, hypotension, or syncope. In this case, the patient’s heart rate is 60 beats per minute, which is within the normal range for sinus bradycardia, and there are no symptoms indicating the need for atropine. Therefore, atropine is not required.

Choice D Reason:

Administering digoxin is also not appropriate. Digoxin is a cardiac glycoside used to treat heart failure and certain types of arrhythmias, such as atrial fibrillation. It can slow the heart rate and increase the force of cardiac contractions. In this scenario, the patient does not have any indications for digoxin therapy, such as heart failure or atrial fibrillation, and their heart rate is already within the normal range. Therefore, digoxin is not indicated.

A. Increased serum albumin B. Decreased serum bilirubin C. Decreased serum ammonia D. Decreased serum alanine aminotransferase (ALT)

Correct Answer is C

Explanation

Choice A Reason: Increased Serum Albumin

Increased serum albumin is not a direct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Albumin is a protein made by the liver, and its levels can be affected by liver function. However, lactulose primarily works by reducing ammonia levels in the blood, not by increasing albumin levels. Normal serum albumin levels range from 3.5 to 5.5 grams per deciliter (g/dL). While improved liver function might eventually lead to increased albumin levels, this is not the primary therapeutic effect of lactulose.

Choice B Reason: Decreased Serum Bilirubin

Decreased serum bilirubin is also not a direct indicator of lactulose’s therapeutic effect. Bilirubin is a byproduct of the normal breakdown of red blood cells and is processed by the liver. Elevated bilirubin levels can indicate liver dysfunction, but lactulose’s main role is to reduce ammonia levels, not bilirubin. Normal serum bilirubin levels are typically between 0.1 to 1.2 milligrams per deciliter (mg/dL). While improved liver function might reduce bilirubin levels, this is not the primary goal of lactulose therapy.

Choice C Reason: Decreased Serum Ammonia

Decreased serum ammonia is the correct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Lactulose is used to treat hepatic encephalopathy, a condition caused by high levels of ammonia in the blood due to liver dysfunction. Lactulose works by converting ammonia into ammonium, which is then excreted from the body. Normal serum ammonia levels are less than 50 micromoles per liter (µmol/L) in adults56. A decrease in serum ammonia levels indicates that lactulose is effectively reducing the toxic levels of ammonia in the blood, thereby achieving its desired therapeutic effect.

Choice D Reason: Decreased Serum Alanine Aminotransferase (ALT)

Decreased serum alanine aminotransferase (ALT) is not a direct indicator of lactulose’s therapeutic effect. ALT is an enzyme found in the liver that helps convert proteins into energy for liver cells. Elevated ALT levels can indicate liver damage. Normal ALT levels range from 7 to 56 units per liter (U/L). While improved liver function might reduce ALT levels, lactulose’s primary role is to reduce ammonia levels, not directly affect ALT.

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A client with Parkinson’s disease (PD) is being discharged home with his wife. To ensure success with the management plan, which discharge action is most effective?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

The nurse is caring for a client diagnosed with chronic hepatitis who is receiving the medication lactulose. Which of these laboratory results would indicate the medication is achieving the desired therapeutic effect?

Correct Answer is C

Explanation

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