A nurse is caring for a client who has meningitis, a temperature of 39.7° C (103.5° F) and is prescribed a hypothermia blanket.
While using this therapy, the nurse should know that the client must carefully be observed for which of the following complications?
Dehydration.
Shivering.
Seizures.
Burns.
The Correct Answer is B
The correct answer is choice B: Shivering.
Choice A rationale: Dehydration is a risk associated with high fever and infections like meningitis, but it is not a direct complication of using a hypothermia blanket.
Choice B rationale: Shivering is a complication of using a hypothermia blanket, as the body may react to the induced cooling by shivering, which can raise body temperature and counteract the blanket's cooling effect.
Choice C rationale: Seizures can occur in meningitis cases, but they are not specifically a complication of using a hypothermia blanket.
Choice D rationale: Burns are not a typical complication of using a hypothermia blanket when it is used as directed and monitored appropriately. However, skin irritation may occur in some cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Alteration in body image is a concern, but it’s not the priority. The priority is addressing the client’s physiological needs first.
Choice B rationale:
Impaired tissue perfusion is the priority nursing diagnosis. Varicose veins with ulcerations and edema indicate poor blood flow, which can lead to tissue damage if not addressed.
Choice C rationale:
Impaired skin integrity is a concern due to the ulcerations, but it’s secondary to impaired tissue perfusion.
Choice D rationale:
Alteration in activity tolerance may be present due to the feeling of heaviness, but it’s not the priority.
Correct Answer is D
Explanation
Choice A rationale:
This statement is incorrect. Impulsive behavior is more commonly associated with right hemispheric CVAs.
Choice B rationale:
This statement is incorrect. A left hemispheric CVA typically results in right-side motor function impairment.
Choice C rationale:
This statement is incorrect. Loss of depth perception is more commonly associated with right hemispheric CVAs.
Choice D rationale:
This statement is correct. Left hemispheric CVAs often result in language and speech impairments, so establishing effective communication would be a key goal in rehabilitation.
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