The patient is a 65-year-old male admitted to the medical surgical unit after a total cholecystectomy.
He has a past medical history of hypertension, heart failure, type 1 diabetes mellitus, cholelithiasis, and cholangitis. Which physician orders would the nurse anticipate being prescribed after reporting findings? Select all that apply.

Obtain arterial blood gases (ABGs) prior to procedure.

Explain that the patient may be placed in five positions.

Perform the drainage immediately after meals.

Instruct the patient to breathe shallow and fast.

Answer and Explanation

Correct Answer : B,C

Choice B rationale:

Gravity Facilitates Drainage:

Positioning the patient strategically utilizes gravity to encourage the flow of fluids and secretions away from the surgical site. This aids in preventing fluid accumulation and potential infection.

Reduces Pressure on Surgical Site:

Certain positions can minimize pressure on the incision and internal organs, promoting healing and reducing discomfort.

This is particularly important for patients with comorbidities like hypertension and heart failure, as they may have impaired wound healing and be more susceptible to respiratory complications.

Enhances Respiratory Function:

Specific positions can improve lung expansion and ventilation, which is essential for patients with a history of heart failure or respiratory issues.

This helps prevent atelectasis (collapsed lung areas) and pneumonia, which are common postoperative risks.

Common Post-Cholecystectomy Positions:

Semi-Fowler's Position:

The head of the bed is elevated 30-45 degrees, with knees slightly bent.

This position eases breathing, reduces pressure on the incision, and promotes drainage of fluids. Right Side-Lying Position:

The patient lies on their right side with a pillow between their knees.

This position encourages drainage from the liver and gallbladder, aiding in bile flow. Left Side-Lying Position:

The patient lies on their left side with a pillow between their knees.

This position promotes drainage from the stomach and pancreas, assisting in digestion. Supine Position:

The patient lies flat on their back with a pillow under their knees.

This position may be used for short periods, but prolonged supine positioning can increase pressure on the incision and lungs. High Fowler's Position:

The head of the bed is elevated 60-90 degrees, with knees slightly bent.

This position is often used for patients with respiratory issues or difficulty breathing, as it improves lung expansion.

Choice C rationale:

Performing drainage immediately after meals aids in efficient removal of bile and gastric secretions, preventing complications such as:

Bile Reflux:

Delayed drainage can cause bile to back up into the stomach, leading to nausea, vomiting, and discomfort. Infection:

Accumulation of fluids in the surgical site can increase the risk of bacterial growth and infection. Pancreatitis:

In rare cases, delayed drainage can cause inflammation of the pancreas due to obstruction of the pancreatic duct.

I'll address the rationales for choices A and D in the following sections.

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Correct Answer is B

Explanation

Choice B rationale:

Isoniazid's Mechanism of Action:

It targets and inhibits the synthesis of mycolic acids, which are essential components of the cell wall of Mycobacterium tuberculosis, the bacteria that cause tuberculosis.

By disrupting cell wall formation, isoniazid prevents bacterial growth and multiplication, leading to the suppression and eventual eradication of the infection.

Clinical Manifestations of Active TB:

Persistent cough, often productive of sputum (phlegm), is a hallmark symptom of TB. The sputum may contain blood or have a rusty-colored appearance.

Other common symptoms include fever, night sweats, fatigue, weight loss, and chest pain. How Isoniazid Reduces Cough and Sputum:

As isoniazid effectively kills the TB bacteria, the inflammatory process within the lungs subsides.

This leads to a gradual decrease in the production of sputum, which is a direct result of the inflammatory response. Consequently, the frequency and severity of coughing episodes also diminish.

Monitoring Treatment Response:

Regular sputum smears and cultures are essential to assess the response to treatment.

A positive sputum smear indicates the presence of live TB bacteria, while a positive culture confirms their growth in the laboratory.

A gradual decrease in the number of bacteria seen on sputum smears, followed by negative cultures, signals a favorable response to treatment.

Timeframe for Improvement:

It's important to note that clinical improvement, including a reduction in cough and sputum, may not be immediately evident. It typically takes several weeks of consistent isoniazid therapy to achieve noticeable results.

Therefore, adherence to the prescribed treatment regimen is crucial for successful TB eradication. Addressing Other Choices:

Choice A: Decreased appetite and weight loss are often associated with active TB due to systemic inflammation and nutritional deficiencies. While isoniazid treatment may indirectly improve appetite and weight gain over time, these are not primary indicators of its effectiveness in suppressing the TB infection itself.

Choice C: Vertigo and tinnitus are potential side effects of isoniazid, but they do not reflect its efficacy in treating TB.

Choice D: A positive sputum smear and culture would indicate ongoing TB infection and a lack of response to treatment.

A. Check the patient’s temperature again. B. Monitor the patient’s heart rate. C. Observe the patient’s breathing. D. Check the patient’s blood pressure.

Correct Answer is C

Explanation

Choice A rationale:

Checking the patient's temperature again is not a priority at this time. The patient's temperature is within the normal range, and there is no indication that it is the cause of the patient's hypoxia.

Focusing on temperature measurement could delay more crucial interventions to address the patient's breathing difficulty.

Choice B rationale:

While monitoring the patient's heart rate is important, it is not the most immediate priority in this situation. The patient's heart rate is elevated, but it is not dangerously high.

The elevated heart rate is likely a compensatory response to the patient's low oxygen saturation. Addressing the underlying cause of the hypoxia, which is likely respiratory in nature, will also help to stabilize the heart rate.

Choice C rationale:

Observing the patient's breathing is the most important action the nurse can take at this time. The patient's respirations are rapid and shallow, indicating respiratory distress.

This is a serious condition that requires immediate intervention. By observing the patient's breathing, the nurse can assess the severity of the distress and determine the best course of action.

The nurse can observe for signs of increased work of breathing, such as use of accessory muscles, nasal flaring, and retractions. They can also auscultate the lungs to assess for any abnormal breath sounds, such as wheezing or crackles.

This information will help the nurse to determine the underlying cause of the respiratory distress and to initiate appropriate interventions, such as administering oxygen, positioning the patient, or calling for assistance from a respiratory therapist.

Choice D rationale:

Checking the patient's blood pressure is not a priority at this time. The patient's blood pressure is within the normal range. While it is important to monitor the patient's blood pressure, it is not the most immediate concern in this situation.

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Naxlex Comprehensive Predictor Exams

The antitubercular drug isoniazid is prescribed for a client with active tuberculosis.To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?

Correct Answer is B

Explanation

The patient’s vital signs are as follows: Temperature 97.5 F (36.4 C), Heart rate 104 beats/minute, Respirations 29 breaths/minute, Blood pressure 119/82 mm Hg, Oxygen saturation 89%. Oxygen mask applied.What should the nurse do next?

Correct Answer is C

Explanation

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While changing a client’s postoperative dressing, the nurse observes purulent drainage at the wound.Before reporting this finding to the healthcare provider, which of the client’s laboratory values should the nurse note?

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