A nurse is reviewing the medical record of a client who has been diagnosed with pneumonia.
Which of the following data should the nurse use to evaluate the effectiveness of the treatment plan?
The client's temperature is 37.2°C (99°F).
The client's white blood cell count is 12.5 x 10^9/L.
The client's oxygen saturation is 95% on room air.
The client's chest x-ray shows clear lung fields
The Correct Answer is D
The client's chest x-ray shows clear lung fields.
Rationale: A chest x-ray is a diagnostic test that can confirm the presence or absence of pneumonia by showing areas of consolidation or infiltration in the lung tissue. A clear chest x-ray indicates resolution of pneumonia and effectiveness of treatment.
Incorrect options:
A) The client's temperature is 37.2°C (99°F). - This is a normal finding, but it does not rule out pneumonia as some clients may have low-grade fever or no fever at all with pneumonia.
B) The client's white blood cell count is 12.5 x 10^9/L. - This is an elevated finding, as the normal range for white blood cell count is 4.5 to 11 x 10^9/L. An elevated white blood cell count indicates inflammation or infection and does not reflect the effectiveness of treatment.
C) The client's oxygen saturation is 95% on room air. - This is a normal finding, as the normal range for oxygen saturation is 95% to 100%. However, it does not indicate the severity or resolution of pneumonia, as some clients may have normal oxygen saturation despite having pneumonia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The Glasgow Coma Scale (GCS) is a tool that measures the level of consciousness based on three parameters: eye opening, verbal response, and motor response. The GCS score ranges from 3 to 15, with lower scores indicating lower levels of consciousness.
Incorrect options:
B) Mini-Mental State Examination (MMSE) - This is a tool that measures cognitive function, such as orientation, memory, attention, and language. It is not used to assess level of consciousness.
C) Confusion Assessment Method (CAM) - This is a tool that screens for delirium, which is an acute and fluctuating disturbance of cognition and attention. It is not used to assess level of consciousness.
D) Morse Fall Scale (MFS) - This is a tool that assesses the risk of falling in hospitalized clients based on six factors: history of falling, secondary diagnosis, ambulatory aid, intravenous therapy, gait, and mental status. It is not used to assess level of consciousness.
Correct Answer is D
Explanation
Rationale: The nurse should document all relevant and objective data obtained from the assessment, including vital signs, skin condition, bowel sounds, and any other findings that reflect the client's health status.
Incorrect options:
A) The client's vital signs are within normal limits. - This is a correct statement, but it is not the only information that should be documented.
B) The client's skin is warm, dry, and intact. - This is a correct statement, but it is not the only information that should be documented.
C) The client's bowel sounds are present in all four quadrants. - This is a correct statement, but it is not the only information that should be documented.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.