A nurse is planning care for an older adult client who has manifestations of dehydration. Which of the following interventions should the nurse include in the plan?

Offer oral fluids every 4 hr.

Monitor the client's hemoglobin level.

Check urinary output status every 4 hr.

Administer furosemide IV.

Answer and Explanation

The Correct Answer is C

A. Offer oral fluids every 4 hr: Offering oral fluids every 4 hours may not be frequent enough for a client with dehydration. The nurse should encourage the client to drink fluids more regularly (e.g., every 1-2 hours) to help prevent further dehydration.

B. Monitor the client's hemoglobin level: Monitoring the hemoglobin level is not a priority intervention for managing dehydration. The focus should be on fluid replacement and monitoring indicators of dehydration, such as urine output.

C. Check urinary output status every 4 hr: Monitoring urinary output regularly is crucial for assessing hydration status. Dehydration often leads to reduced urine output, and it is important to check for changes in output to adjust fluid intake and assess the effectiveness of interventions.

D. Administer furosemide IV: Furosemide is a diuretic, which increases urine output. Administering it to a client who is dehydrated would worsen their dehydration and is contraindicated. The focus should be on rehydration, not on further increasing fluid loss.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A. It is important to provide the client with all options available, including risks, benefits, and alternatives to the surgery. Telling the client that the procedure is the only option may limit their autonomy and decision-making ability.

B. The nurse should reinforce the information already provided by the surgeon and clarify any questions the client may have. This ensures that the client is fully informed and can make an educated decision about their care. Encouraging open communication helps the client feel more comfortable with their decision.

C. This response disregards the client’s right to make decisions about their own care. The client must be given the opportunity to express concerns and make an informed choice about their treatment.

D. Persuading the client to undergo surgery is not appropriate. The nurse should support the client’s decision-making process, providing clear and accurate information while respecting their autonomy. Coercion is unethical and does not align with patient-centered care.

A. Place a tongue blade at the bedside. B. Dim the overhead lights. C. Assist the client to ambulate every 4 hr. D. Apply a warming blanket. E. Have suction equipment at the bedside.

Correct Answer is ["B","E"]

Explanation

A. Place a tongue blade at the bedside: Inserting an object into the mouth during a seizure can lead to airway obstruction, dental injury, or harm to the client. The focus should be on ensuring the client’s safety and airway clearance without inserting any objects.

B. Dim the overhead lights: Dim lighting can help reduce external stimuli that might trigger a seizure. Bright or harsh lights can sometimes exacerbate seizures, so it’s important to create a calm environment that helps prevent further stimulation or agitation.

C. Assist the client to ambulate every 4 hr: Ambulation is not a priority during a seizure or in the immediate post-seizure period. The client’s safety should be ensured by limiting activities that could result in injury, such as walking, especially if they are at risk for more seizures.

D. Apply a warming blanket: Applying a warming blanket is not recommended, especially in the presence of meningitis, as it can increase the risk of hyperthermia. Meningitis can already cause fever, and adding heat may worsen the condition.

E. Have suction equipment at the bedside: Suction equipment should always be available for clients experiencing seizures. This ensures that any secretions or vomit can be cleared quickly to maintain a clear airway, which is essential during and after a seizure.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is planning care for an older adult client who has manifestations of dehydration. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled for heart surgery. Prior to surgery the client states, "I'm not sure I want to go through with this procedure after all." Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is planning care for a client who is experiencing seizures secondary to meningitis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

Correct Answer is ["B","E"]

Explanation

A nurse is teaching a client who has angina about sublingual nitroglycerin. Which of the following instructions should the nurse include?

A nurse is reviewing providers' prescriptions for four clients. Which of the following prescriptions should the nurse verify with the provider?

A nurse is caring for a client who is 2 hr postoperative following orthopedic surgery and reports pain as 10 on a scale of 0 to 10. Which of the following prescriptions should the nurse expect to administer?

A nurse in a provider's office is caring for a client. Exhibits Which of the following findings require follow-up? Select all that apply.

A nurse is teaching a group of young adult clients about risk factors for hearing loss. Which of the following factors should the nurse include in the teaching? (Select all that apply.)

A nurse in a provider's office is caring for a client. Exhibits For each client's finding, click to specify if the assessment finding is consistent with sickle cell disease, iron deficiency anemia, and/or pernicious anemia. Each finding may support more than 1 disease process.

A nurse is caring for a client who has thrombocytopenia due to chemotherapy treatment. Which of the following actions should the nurse take?

A nurse is caring for a client who has end-stage liver disease and is being placed on a transplant list. Which of the following statements by the client is the priority for the nurse to report to the provider?