A nurse is caring for an older client on a medical-surgical unit.Which of the following interventions should be included in the plan of care?

Monitor the client’s hydration status.

Encourage the client to engage in physical activities.

Administer medications as prescribed.

Educate the client on dietary needs.

Answer and Explanation

The Correct Answer is A

Choice A rationale
Monitoring the client’s hydration status is critical for older adults, especially those on a medical-surgical unit, to prevent dehydration, which can lead to serious complications such as renal impairment, confusion, and electrolyte imbalance.
Choice B rationale
Encouraging physical activities is beneficial but is not always feasible or safe for all older clients, especially those with certain medical conditions or mobility limitations.
Choice C rationale
Administering medications as prescribed is essential but is a standard practice for all clients and not specific to older adults' unique needs.
Choice D rationale
Educating the client on dietary needs is important but secondary to monitoring hydration, which addresses more immediate physiological needs and complications.

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Correct Answer is ["B","C","D"]

Explanation

Choice A rationale: Contact precautions are not necessary in this situation as the client is presenting symptoms of a possible infection related to chemotherapy-induced immunosuppression, not a contagious disease.
Choice B rationale: Placing the client in a private room is crucial to protect her from potential infections, given her compromised immune system due to chemotherapy.
Choice C rationale: Encouraging the client to increase fluid intake can help manage fever and muscle aches and keep her hydrated, which is important when dealing with symptoms of infection and fatigue.
Choice D rationale: Wearing a mask when caring for the client is necessary to protect both the client and the healthcare provider from potential infections, considering the client’s immunocompromised state.
Choice E rationale: Preparing to administer an antibiotic should be based on the healthcare provider's orders and further diagnostic results. While it might be necessary, it is not an immediate nursing action without provider confirmation.

A. Platelets. B. Calcium. C. Absolute neutrophil count (ANC). D. White blood cells (WBCs).

Correct Answer is B

Explanation

Choice A rationale
Metastatic bone cancer does not typically result in an increase in platelet count. Platelets are involved in blood clotting, and their levels are not usually affected by bone metastases.
Choice B rationale
Calcium levels are often increased in clients with metastatic bone cancer due to the breakdown of bone tissue releasing calcium into the bloodstream.
Choice C rationale
Absolute neutrophil count (ANC) is not typically increased in metastatic bone cancer. ANC levels are more directly related to infections and bone marrow function.
Choice D rationale
White blood cell (WBC) count is not typically increased in metastatic bone cancer. Elevated WBC levels are more commonly associated with infection or inflammation.

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A nurse is caring for an older client on a medical-surgical unit.Which of the following interventions should be included in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["B","C","D"]

Explanation

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Correct Answer is B

Explanation

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