A nurse is caring for a client with dengue shock syndrome (DSS) Which of the following nursing interventions is the highest priority for this client?

Providing mosquito netting around the bed.

Administering herbal remedies for pain relief.

Monitoring vital signs and fluid status closely.

Encouraging the client to engage in physical activities.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Providing mosquito netting around the bed is not the highest priority for a client with dengue shock syndrome (DSS) DSS is a severe form of dengue fever characterized by plasma leakage, bleeding, and organ failure. While mosquito bites should be avoided, the priority is to manage the client's critical condition and complications.

Choice B rationale:

Administering herbal remedies for pain relief is not the highest priority for a client with DSS. Pain relief is important, but the priority lies in addressing the life-threatening manifestations of DSS, such as maintaining adequate fluid balance and preventing further complications.

Choice C rationale:

Monitoring vital signs and fluid status closely is the highest priority for a client with DSS. DSS can lead to severe dehydration, hypovolemic shock, and circulatory collapse. Close monitoring of vital signs and fluid status allows early detection of any worsening condition and enables prompt intervention.

Choice D rationale:

Encouraging the client to engage in physical activities is not appropriate for a client with DSS. In fact, physical activities should be restricted for a client with severe dengue to prevent complications and excessive strain on the cardiovascular system. Rest is essential for recovery.

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Correct Answer is C

Explanation

Choice A rationale:

The patient's vaccination history is not directly relevant to confirming a suspected case of dengue fever. Vaccination for dengue fever is not widely available, and the diagnosis relies on other factors.

Choice B rationale:

While exposure to water sources may be relevant in some infectious diseases, it does not specifically confirm or rule out a suspected case of dengue fever.

Choice C rationale:

The patient's travel itinerary and dates are crucial in confirming a suspected case of dengue fever. Knowing the patient's recent travel to a tropical region with a high incidence of dengue fever is essential for accurate diagnosis and appropriate management.

Choice D rationale:

The patient's dietary habits are not directly related to confirming a suspected case of dengue fever. While nutrition is important for overall health, it does not impact the diagnosis of the disease.

A. Assessing signs of bleeding and organ failure. B. Providing supplemental oxygen as needed. C. Monitoring intake and output. D. Administering antipyretics for fever control.

Correct Answer is A

Explanation

Choice A rationale:

During the critical phase of dengue fever, which typically occurs around 3-7 days after the onset of symptoms, the client is at a higher risk of developing severe bleeding and organ failure due to plasma leakage and decreased platelet counts. Assessing for signs of bleeding, such as petechiae, ecchymosis, gum bleeding, or hematuria, is essential to detect any worsening condition promptly. Additionally, monitoring for signs of organ failure, such as altered mental status, respiratory distress, or oliguria, is crucial for timely intervention and appropriate management.

Choice B rationale:

Providing supplemental oxygen as needed may be beneficial in certain cases of dengue fever with respiratory distress or hypoxemia. However, during the critical phase, the priority is to assess for bleeding and organ failure, as these complications pose a more immediate threat to the client's life.

Choice C rationale:

Monitoring intake and output is a crucial nursing intervention for clients with dengue fever to ensure adequate hydration and prevent dehydration. While this is essential throughout the course of the illness, it is not the priority during the critical phase when bleeding and organ failure are of greater concern.

Choice D rationale:

Administering antipyretics for fever control may be necessary in the febrile phase of dengue fever to alleviate discomfort and manage fever. However, during the critical phase, the priority shifts to assessing for and managing potentially life-threatening complications like bleeding and organ failure.

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A nurse is caring for a client with dengue shock syndrome (DSS) Which of the following nursing interventions is the highest priority for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a patient who recently traveled to a tropical region. The patient complains of sudden fever and headache. What additional information would be most helpful to confirm a suspected case of dengue fever?

Correct Answer is C

Explanation

A nurse is caring for a client with dengue fever in the critical phase. Which nursing intervention is a priority during this phase?

Correct Answer is A

Explanation

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