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.
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
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Monitoring skin color is not specifically required for clients on ethambutol therapy. While changes in skin color can indicate various health issues, they are not directly related to the side effects of ethambutol.
Choice B reason:
Visual acuity should be monitored because ethambutol can cause optic neuropathy, which can lead to vision loss. Regular eye exams, including tests for visual acuity and color discrimination, are recommended to detect any early signs of optic nerve damage.
Choice C reason:
Monitoring cardiac rhythm is not specifically required for clients on ethambutol therapy. Ethambutol does not typically affect the heart’s rhythm. Cardiac monitoring would be more relevant for medications that have known cardiotoxic effects.
Choice D reason:
Monitoring urine output is not specifically required for clients on ethambutol therapy. While renal function should be monitored due to the drug’s excretion through the kidneys, urine output itself is not a primary concern unless there are signs of renal impairment.
Correct Answer is C
Explanation
Choice A reason: Avoiding more time-outs in the OR is not the primary purpose of pre-operative teaching. Time-outs are a safety protocol used in the operating room to ensure that the correct procedure is being performed on the correct patient. While pre-operative teaching can contribute to overall surgical safety, its main goal is not to reduce the number of time-outs.
Choice B reason: Understanding the informed consent is an important aspect of pre-operative teaching, but it is not the primary purpose. Informed consent ensures that the patient is aware of the risks, benefits, and alternatives to the procedure. Pre-operative teaching encompasses a broader range of information, including what to expect before, during, and after surgery.
Choice C reason: Achieving better post-operative outcomes is the primary purpose of pre-operative teaching. Educating patients about their surgery, recovery process, and self-care can significantly improve their post-operative outcomes. This includes reducing anxiety, pain, and complications, as well as shortening hospital stays and enhancing overall recovery. Pre-operative education empowers patients to take an active role in their recovery, leading to better health outcomes.
Choice D reason: Reinforcing that collaborative care is essential is a component of pre-operative teaching, but it is not the primary purpose. Collaborative care involves the coordination of various healthcare professionals to provide comprehensive care to the patient. While pre-operative teaching can highlight the importance of teamwork, its main focus is on preparing the patient for surgery and recovery.
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