A 51-year-old male client with pneumonia has undergone several days of antibiotic and respiratory treatment. Given the following assessment findings, mark whether they indicate that the treatment was effective or ineffective:
PaCO2 55 mm Hg on a blood gas
Rhonchi in the right lung
Oxygen saturation greater than 94%
Client ambulates without shortness of breath
Correct Answer : C,D
Choice A rationale:
PaCO2 55 mm Hg on a blood gas indicates ineffective treatment. Normal PaCO2 levels range from 35-45 mm Hg.
Elevated PaCO2 (hypercapnia) suggests that the lungs are not effectively removing carbon dioxide from the body. This can be due to various factors, including:
Incomplete resolution of pneumonia Airway obstruction
Impaired respiratory muscle function
Choice B rationale:
Rhonchi in the right lung indicates ineffective treatment.
Rhonchi are coarse, rattling sounds heard in the lungs during auscultation.
They are often associated with mucus accumulation in the airways, which can occur in pneumonia.
The presence of rhonchi suggests that inflammation and mucus production persist, despite antibiotic and respiratory therapy.
Choice C rationale:
Oxygen saturation greater than 94% indicates effective treatment. Normal oxygen saturation levels are typically 95% or higher.
A saturation of 94% or above suggests that the lungs are able to effectively oxygenate the blood. This is a positive sign that the pneumonia is responding to treatment.
Choice D rationale:
Client ambulates without shortness of breath indicates effective treatment. Shortness of breath (dyspnea) is a common symptom of pneumonia.
It occurs when the lungs are unable to provide enough oxygen to the body, leading to a feeling of breathlessness.
The ability to ambulate without shortness of breath suggests that the pneumonia has improved and that the lungs are functioning more effectively.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is C
Explanation
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.
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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