The client with right lower lobe pneumonia has been treated with intravenous antibiotics for three days. Which assessment data obtained by the nurse indicates that the treatment has been effective?

Pulse oximetry is 90%.

White blood cell count is 9000/µL.

Bronchial breath sounds are heard at the right base.

Sputum is light yellow in color.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Pulse oximetry is 90% is not an ideal indicator of effective treatment. A normal pulse oximetry reading is typically between 95% and 100%. A reading of 90% suggests that the patient may still be experiencing hypoxemia, which indicates that the pneumonia may not be fully resolved.

Choice B reason:

White blood cell count is 9000/µL is a strong indicator that the treatment has been effective. A normal white blood cell (WBC) count ranges from 4,000 to 11,000/µL. An elevated WBC count is often seen in infections, and a return to normal levels suggests that the infection is resolving.

Choice C reason:

Bronchial breath sounds heard at the right base are not typically a sign of improvement. These sounds can indicate consolidation or fluid in the lungs, which are common in pneumonia. Effective treatment should result in the reduction of abnormal breath sounds.

Choice D reason:

Sputum that is light yellow in color does not necessarily indicate effective treatment. While a change in sputum color can be a sign of improvement, it is not as reliable as other clinical indicators such as WBC count or improvement in symptoms

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Correct Answer is C

Explanation

Choice A reason:

Notifying the physician immediately is not the first action to take. While it is important to keep the physician informed, the nurse should first implement measures to alleviate the client’s pain and discomfort.

Choice B reason:

Increasing the oxygen from 2 to 4 liters/minute may be necessary if the client is experiencing hypoxia, but it is not directly related to managing pleuritic chest pain. The primary focus should be on pain relief and comfort.

Choice C reason:

Teaching about splinting the chest when coughing is the most appropriate action. Splinting helps to reduce pain by stabilizing the chest wall during coughing, which can be particularly painful for clients with pleuritic chest pain.

Choice D reason:

Obtaining an electrocardiogram (ECG) is not immediately necessary for managing pleuritic chest pain caused by pneumonia. An ECG may be indicated if there are concerns about cardiac issues, but it is not the primary intervention for pleuritic pain.

A. Weigh the patient prior to the procedure. B. Use extra padding on bony prominences. C. Use extra safety straps. D. Notify the surgeon.

Correct Answer is D

Explanation

Choice A reason: Weighing the patient prior to the procedure is a standard practice and ensures accurate dosing of medications and anesthesia. However, it does not address the immediate concern of the patient being underweight, which could impact their surgical and recovery outcomes.

Choice B reason: Using extra padding on bony prominences is important for preventing pressure ulcers, especially in underweight patients who have less natural padding. While this is a necessary precaution, it does not directly address the underlying issue of the patient’s nutritional status.

Choice C reason: Using extra safety straps can help secure the patient during surgery, but it does not address the nutritional concerns that could affect the patient’s recovery and overall health.

Choice D reason: Notifying the surgeon is crucial because the patient’s underweight status could significantly impact their surgical risk and recovery. The surgeon needs to be aware of this to make any necessary adjustments to the surgical plan or to involve a nutritionist or other specialists to address the patient’s nutritional needs before and after surgery.

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The client with right lower lobe pneumonia has been treated with intravenous antibiotics for three days. Which assessment data obtained by the nurse indicates that the treatment has been effective?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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