A client has begun reporting nausea and vomiting.
What would the nurse assess to determine the need for therapy?
Number of times client’s family reports the client is nauseated.
How well the client is eating.
Color and amount of vomit, and frequency of vomiting episodes.
Client’s nutritional status and fluid balance.
The Correct Answer is C
The nurse would assess these factors to determine the need for therapy. Some possible explanations for the other choices are:
Choice A. Number of times client’s family reports the client is nauseated.
This is not a reliable indicator of the severity or cause of nausea and vomiting.
The nurse should assess the client directly and not rely on the family’s reports.
Choice B. How well the client is eating.
This is not a specific or objective measure of nausea and vomiting.
The client may have other reasons for not eating well, such as loss of appetite, taste changes, or pain.
The nurse should also monitor the client’s weight, hydration status, and electrolyte levels.
Choice D. Client’s nutritional status and fluid balance.
These are important aspects of the client’s overall health, but they are not directly related to nausea and vomiting.
The nurse should assess these factors as part of the comprehensive care plan, but they are not sufficient to determine the need for therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The CTZ has to be stimulated in order for vomiting to occur. The CTZ is located in the area postrema of the medulla oblongata and receives input from various sources, such as the blood, the vestibular system, and the gastrointestinal tract.
Choice A is wrong because the limbic system involves emotion, not vomiting or other forms of GI function.
Choice B is wrong because the hypothalamus regulates various functions such as body temperature, hunger, thirst, and circadian rhythms, but not vomiting.
Choice D is wrong because the medulla oblongata is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting, but it is not the site of stimulation for vomiting.
The medulla oblongata contains the vomiting center, which receives signals from the CTZ and other sources and initiates the act of vomiting.
Correct Answer is A
Explanation
Desmopressin is a synthetic analog of antidiuretic hormone (ADH) that acts on the kidneys to increase water reabsorption and decrease urine output. Neurogenic diabetes insipidus is a condition caused by a deficiency of ADH due to damage to the hypothalamus or pituitary gland. Patients with this condition have excessive thirst and urination, dehydration, and low urine specific gravity.
Choice B. Methylprednisolone is wrong because it is a corticosteroid that suppresses inflammation and immune response.
It is not used to treat diabetes insipidus.
Choice C. Dexamethasone is wrong because it is also a corticosteroid that has similar effects as methylprednisolone.
It is not used to treat diabetes insipidus.
Choice D. Physostigmine is wrong because it is a cholinesterase inhibitor that increases the levels of acetylcholine in the body.
It is used to treat myasthenia gravis and anticholinergic poisoning.
It has no effect on diabetes insipidus.
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