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. Chocolate and peppermint can relax the lower esophageal sphincter, worsening GERD symptoms. These should be avoided.
B. Oatmeal with banana slices is a good choice because it is low in fat and acid, which helps prevent GERD symptoms. Bananas are also a non-acidic fruit that is generally well-tolerated.
C. Spaghetti with tomato sauce contains acidic ingredients that can irritate the esophagus and worsen GERD symptoms.
D. A cheeseburger with grilled onions is high in fat, which can delay gastric emptying and increase reflux. Onions are also a known trigger for GERD symptoms.
Correct Answer is A
Explanation
A. Hemoglobin A1C of 7.2 is diagnostic for diabetes. An A1C of 6.5% or higher is diagnostic for diabetes, as it reflects the average blood glucose levels over the past 2-3 months.
B. Fasting plasma glucose of 98 mg/dl is within the normal range (70-99 mg/dl). A fasting plasma glucose of 126 mg/dl or higher is diagnostic for diabetes.
C. Two-hour plasma glucose of 140 mg/dl is within the normal range (less than 140 mg/dl after a glucose tolerance test). A two-hour plasma glucose of 200 mg/dl or higher is diagnostic for diabetes.
D. Random plasma glucose of 110 mg/dl is within the normal range. A random plasma glucose of 200 mg/dl or higher, along with symptoms of hyperglycemia, would be diagnostic for diabetes.
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