A client with hypovolemia is at risk for orthostatic hypotension. Which of the following interventions should the nurse implement in this client?
Encourage the client to change positions
Encourage the client to exercise vigorously
Encourage the client to stand for extended periods
Encourage the client to limit fluid intake
The Correct Answer is A
A. Encouraging the client to change positions slowly, such as moving from lying to sitting and then to standing, helps to minimize the risk of orthostatic hypotension. This gradual change allows the body to adjust to positional changes without causing a sudden drop in blood pressure.
B. Encouraging vigorous exercise is not recommended for a client with hypovolemia as it could exacerbate the condition, potentially causing dizziness, fainting, or further lowering blood pressure.
C. Encouraging the client to stand for extended periods is not appropriate for a client at risk for orthostatic hypotension, as standing for prolonged periods can cause blood to pool in the lower extremities, increasing the risk of fainting or dizziness.
D. Encouraging the client to limit fluid intake is inappropriate for a client with hypovolemia. Adequate fluid intake is crucial to help restore blood volume and prevent hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While having the son verify understanding may seem appropriate, using a family member as a translator is not acceptable for informed consent due to the potential for miscommunication or bias.
B. Contacting the hospital translator ensures accurate and professional communication. A certified translator is required for legal and ethical reasons to ensure the patient fully understands the procedure, risks, and benefits.
C. Using the son to clarify questions may lead to inaccuracies or incomplete understanding. Professional translation services must be utilized in medical settings.
D. The son does not need to sign the consent form. The provider must ensure the patient understands the procedure, and the consent form is signed by the patient or their legal representative after professional translation.
Correct Answer is ["75"]
Explanation
- Total volume: 1800 mL
- Infusion time: 24 hours
- Calculation: 1800 mL / 24 hours = 75 mL/hour
Therefore, the IV pump should be set to deliver 75 mL/hr.
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