A nurse is assisting in providing care for a client who has multiple organ dysfunction syndrome (MODS). Which of the following actions is the priority when planning care for this client?

Discussing the client's resting times with the family

Ensuring that the client and their family are kept informed about the client's care

Being aware of the client's wishes regarding care

Scheduling periods of rest for the client

Answer and Explanation

The Correct Answer is C

A. Discussing rest times with the family is important but is not the priority in managing MODS.

B. Keeping the client and family informed is crucial, but the priority is to understand and respect the client's wishes regarding their care.

C. In a client with MODS, understanding and respecting the client’s wishes, particularly regarding end-of-life care, is the priority. This ensures that care aligns with the client’s values and goals.

D. Scheduling rest is essential for managing fatigue and conserving energy but does not take precedence over respecting the client's care preferences.

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Correct Answer is C

Explanation

A. A low blood pressure with a low pulse rate is not typical for hypovolemic shock; a low pulse rate would suggest bradycardia, not commonly seen in hypovolemic shock.

B. High blood pressure and high pulse rate are not characteristic of hypovolemic shock; high blood pressure is not usually associated with this condition.

C. In hypovolemic shock, low blood pressure is accompanied by a high pulse rate as the body attempts to compensate for the reduced blood volume.

D. High blood pressure and low pulse rate are not indicative of hypovolemic shock; this combination is not typical for this type of shock.

A. Distended neck veins B. BP 146/94 mm Hg C. Urine specific gravity 1.034 D. Bounding pulse

Correct Answer is C

Explanation

A. Distended neck veins are typically associated with fluid overload, not dehydration.

B. An elevated blood pressure is not a common indicator of dehydration; dehydration often leads to hypotension.

C. An elevated urine specific gravity (greater than 1.030) indicates concentrated urine, which is a sign of dehydration as the body conserves water.

D. A bounding pulse is more indicative of fluid overload rather than dehydration, which often causes a weak, thready pulse.

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A nurse is assisting in providing care for a client who has multiple organ dysfunction syndrome (MODS). Which of the following actions is the priority when planning care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is C

Explanation

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