The nurse is caring for a client who is taking diclofenac for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue.
Which of the client’s serum laboratory values is most important for the nurse to review?
Total protein.
Hemoglobin.
Glucose.
Sodium.
The Correct Answer is B
Choice A rationale:
Total protein is a measure of the overall protein content in the blood. It includes albumin and globulin.
While it can be helpful in assessing nutritional status and liver function, it is not directly relevant to the client's current symptoms of pallor and fatigue.
Decreased total protein can indicate malnutrition or liver disease, but these conditions would not typically cause the specific symptoms of pallor and fatigue.
Therefore, total protein is not the most important laboratory value to review in this case.
Choice B rationale:
Hemoglobin is the protein in red blood cells that carries oxygen throughout the body.
Paleness (pallor) is a common sign of anemia, which is a condition characterized by a low hemoglobin level. Fatigue is also a common symptom of anemia, as the body's tissues are not receiving enough oxygen.
Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), can cause gastrointestinal bleeding, which can lead to anemia. Therefore, it is essential for the nurse to review the client's hemoglobin level to assess for potential anemia.
Choice C rationale:
Glucose is a type of sugar that the body uses for energy.
Abnormal glucose levels can cause various symptoms, including fatigue. However, glucose levels would not typically cause pallor.
Additionally, there is no indication in the question stem that the client has any risk factors for diabetes or other disorders that affect glucose metabolism.
Therefore, glucose is not the most likely cause of the client's symptoms.
Choice D rationale:
Sodium is an electrolyte that helps regulate fluid balance in the body.
Abnormal sodium levels can cause various symptoms, including fatigue and weakness. However, sodium levels would not typically cause pallor.
Additionally, there is no indication in the question stem that the client has any risk factors for electrolyte imbalances. Therefore, sodium is not the most likely cause of the client's symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Observing the skin for lesions is not a specific technique for assessing early signs of rheumatoid arthritis. While RA can sometimes manifest with skin lesions, they are not typically present in the early stages of the disease. Moreover, skin lesions can be indicative of a wide range of other conditions, making them a less reliable indicator of RA.
Choice B rationale:
Palpating the lymph nodes is also not a specific technique for assessing early signs of rheumatoid arthritis. Lymph node enlargement can occur in various inflammatory conditions, including infections and autoimmune diseases. It is not a characteristic feature of early RA.
Choice C rationale:
Palpating large joints for nodules is a technique used to assess for rheumatoid arthritis, but it is more likely to detect nodules in later stages of the disease. Nodules are typically firm, non-tender bumps that develop under the skin around joints. They are often found in areas like the elbows, knuckles, and fingers. However, they may not be present in the early stages of RA.
Choice D rationale:
Observing the client's fingers is the most appropriate technique for assessing early signs of rheumatoid arthritis. This is because the fingers are often the first joints to be affected by the disease. Early signs of RA in the fingers can include:
Swelling of the finger joints, particularly the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. Tenderness and pain in the finger joints, especially upon movement.
Stiffness in the finger joints, which is often worse in the mornings and after periods of inactivity. Redness or warmth in the finger joints.
Difficulty bending or straightening the fingers.
Correct Answer is A
Explanation
Choice A rationale:
Lactulose directly addresses the primary cause of hepatic encephalopathy, which is the accumulation of ammonia in the blood. Ammonia is a neurotoxin that can impair brain function, leading to confusion, lethargy, and even coma. Lactulose works by trapping ammonia in the colon, where it can be safely excreted in the stool. This decrease in ammonia levels in the blood allows for the improvement of mental status.
Studies have consistently shown that lactulose therapy can significantly improve mental function in patients with hepatic encephalopathy. This improvement is often seen within a few days of starting treatment.
The nurse should assess the client's mental status regularly to monitor for improvement. This assessment should include evaluating the client's level of consciousness, orientation, attention, memory, and speech.
Improved mental status is a critical therapeutic goal in the treatment of hepatic encephalopathy. It allows patients to regain their independence and participate more fully in their care.
Choice B rationale:
While lactulose can cause diarrhea, which may lead to a slight increase in urine output, this is not the primary therapeutic response that the nurse should expect.
The increase in urine output is typically secondary to the diarrhea and does not directly reflect a reduction in ammonia levels or improvement in mental status.
Choice C rationale:
Lactulose does cause diarrhea, which is a common side effect of the medication.
However, the goal of lactulose therapy is not to reduce the number of liquid stools but rather to trap ammonia in the colon and promote its excretion.
The nurse should monitor the client's stool frequency and consistency to ensure that they are not experiencing excessive diarrhea, which could lead to dehydration and electrolyte imbalances.
Choice D rationale:
While improved mental status may eventually lead to improved mobility, it is not the most immediate or direct therapeutic response that the nurse should expect from lactulose therapy.
The ability to ambulate independently is more likely to be a long-term goal of treatment, rather than an immediate response to lactulose.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today