The nurse is reviewing the patient's medical records which include history and physical, nurses' notes, imaging studies, and orders.

Exhibits

The nurse is asked to mark whether the assessment findings indicate that the treatment was effective or ineffective.

Which of the following options best describes the effectiveness of the treatment?

The treatment was effective.

The treatment was ineffective.

The treatment was partially effective.

It is too early to determine the effectiveness of the treatment.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Diminished breath sounds in the right lung: This finding suggests that there is still some inflammation or fluid in the right lung, which is not consistent with fully effective treatment. Normal breath sounds should be clear and equal bilaterally.

PaCO2 55 mm Hg on a blood gas: This finding is slightly elevated, indicating that the patient may be having some difficulty clearing carbon dioxide from the lungs. A normal PaCO2 is 35-45 mm Hg.

Rhonchi in the right lung: Rhonchi are a type of abnormal breath sound that is caused by secretions in the airways. This finding suggests that there is still some inflammation or infection in the right lung.

Choice B rationale:

Oxygen saturation greater than 94%: This finding is within the normal range and indicates that the patient is getting enough oxygen.

Client ambulates without shortness of breath: This finding is a positive sign that the patient's respiratory status is improving. Symmetric chest expansion: This finding indicates that both lungs are expanding equally, which is a good sign.

Choice C rationale:

The assessment findings are mixed, with some findings suggesting improvement (oxygen saturation, ambulation without shortness of breath, symmetric chest expansion) and some findings suggesting that the infection is not fully resolved (diminished breath sounds, elevated PaCO2, rhonchi). This suggests that the treatment has been partially effective, but that the patient may need further treatment to fully resolve the pneumonia.

Choice D rationale:

It is important to evaluate the effectiveness of treatment over time, but the assessment findings in this case are clear enough to determine that the treatment has been partially effective.

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Correct Answer is C

Explanation

Choice A rationale:

Chronic pain is a significant concern for this client, but it is not the immediate priority. Pain can be managed with medications and comfort measures, while aspiration can be life-threatening.

Tissue destruction by the tumor is likely contributing to the pain, but addressing the risk of aspiration takes precedence.

Uncontrolled pain can exacerbate anxiety and make it difficult to focus on other interventions, but ensuring airway safety is paramount.

Choice B rationale:

Anxiety and grieving are expected reactions to a diagnosis of esophageal cancer, and they should be addressed as part of the client's care plan. However, they are not the immediate priority in this case.

The progression of the disease is a significant stressor, but attending to the risk of aspiration is essential for the client's safety. Psychological distress can negatively impact coping and quality of life, but addressing physical needs takes precedence.

Choice D rationale:

Imbalanced nutrition is a concern for this client due to dysphagia and anorexia. However, it is not the immediate priority. Nutritional interventions can be implemented once the risk of aspiration is addressed.

Difficulty swallowing can lead to inadequate intake and malnutrition, but ensuring airway safety is the primary concern.

Anorexia can further contribute to nutritional deficits, but preventing aspiration is the most pressing issue.

Choice C is the priority nursing problem because:

The client's dysphagia puts them at immediate risk for aspiration, which can lead to pneumonia, respiratory failure, and even death.

Addressing the risk of aspiration is essential to ensure the client's safety and prevent life-threatening complications. It's crucial to implement interventions to minimize the risk of aspiration, such as:

Elevating the head of the bed during meals and for 30-60 minutes after eating Thickening liquids and pureeing foods

Encouraging small, frequent meals

Monitoring for signs of aspiration, such as coughing, choking, or difficulty breathing

A. Improved mental status. B. Increase in urine output. C. Reduction in number of liquid stools. D. Ability to ambulate independently.

Correct Answer is A

Explanation

Choice A rationale:

Lactulose is a non-absorbable disaccharide that is metabolized by bacteria in the colon to produce lactic acid and acetic acid. These acids acidify the colon, which traps ammonia (NH3) in the colon and converts it to ammonium (NH4+). Ammonium is not absorbed by the colon and is excreted in the stool. This ammonia-lowering effect is the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.

Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with severe liver disease. It is caused by the buildup of ammonia in the blood, which can cross the blood-brain barrier and cause cerebral edema and impaired brain function.

The clinical manifestations of hepatic encephalopathy range from mild confusion and personality changes to coma. Improved mental status is a key therapeutic goal in the treatment of hepatic encephalopathy.

Studies have shown that lactulose can improve mental status in patients with hepatic encephalopathy. A meta-analysis of 11 randomized controlled trials found that lactulose was associated with a significant improvement in mental status compared to placebo.

The improvement in mental status is typically seen within 24 to 48 hours of starting lactulose therapy.

Choice B rationale:

Increased urine output is not a direct therapeutic effect of lactulose. Lactulose can cause diarrhea, which can lead to increased urine output due to fluid loss. However, this is not the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.

Choice C rationale:

Reduction in the number of liquid stools is a common side effect of lactulose. However, it is not a therapeutic goal in the treatment of hepatic encephalopathy. The goal of lactulose therapy is to improve mental status by lowering ammonia levels in the blood.

Choice D rationale:

Ability to ambulate independently is not a direct therapeutic effect of lactulose. Lactulose can improve mental status, which may indirectly lead to improved ambulation in some patients. However, this is not the primary mechanism by which lactulose works.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has been admitted with a diagnosis of esophageal cancer.The client reports a pain level of 8 on a 0 to 10 pain scale, dysphagia, anorexia, anxiety, and a hoarse voice. Which nursing problem is the priority for this client?

Correct Answer is C

Explanation

A client has been administered lactulose for several days.Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?

Correct Answer is A

Explanation

A client with psoriasis returns to the clinic reporting the persistence of several silvery, scaly areas on the elbows and palms that frequently burn and sometimes bleed. Which prescription should the nurse teach the client to use for the skin condition?

The nurse notes that a patient has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete?

The nurse is admitting a client with possible tuberculosis (TB). The client is placed in a private room with airborne precautions pending diagnostic test results.Which diagnostic test should the nurse review to confirm the diagnosis of TB?

A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in "500 mg per 100 ml" of dextrose 5% in water. To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr?

The healthcare provider prescribes an IV solution of clindamycin 850 mg in 75 ml of D5W to infuse over 30 minutes. The drop factor is 15 gtt/mL. The nurse should regulate the IV to deliver how many gtt/minute? (Enter numeric value only. If rounding is required, round to the nearest whole number.)