An adult woman with Grave's disease is admitted with severe dehydration and malnutrition. She is currently restless and refusing to eat. Which action is most important for the nurse to implement?

Keep room temperature cool.

Determine the client's food preferences.

Maintain a patent intravenous site.

Teach the client relaxation techniques.

Answer and Explanation

The Correct Answer is C

Choice A reason: Keeping the room temperature cool may help with comfort but is not the immediate priority.

Choice B reason: Determining the client's food preferences is important for nutritional management but is not the first action to take.

Choice C reason:

The correct answer is c) because maintaining a patent intravenous site is crucial for administering fluids and medications to address severe dehydration and malnutrition.

Choice D reason: Teaching relaxation techniques can help with restlessness but is not the most immediate concern.

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Correct Answer is A

Explanation

Choice A reason:

The correct answer is a) because obtaining a specimen for culture is essential to diagnose a potential sexually transmitted infection and guide appropriate treatment.

Choice B reason: Observing for a chancre-like lesion may be part of the assessment but is not the first step.

Choice C reason: Identifying sexual partners is important for contact tracing but is secondary to obtaining a diagnostic specimen.

Choice D reason: Assessing for itching and erythema is important but not the immediate priority.

A. Provide the client with additional oral fluids of her preference. B. Measure the client's capillary glucose reading at regular intervals. C. Encourage the client to use hard candy frequently to help relieve thirst. D. Withhold the next diuretic dose until contacting the healthcare provider.

Correct Answer is D

Explanation

Choice A reason: Providing additional oral fluids is not appropriate for SIADH and can worsen fluid retention.

Choice B reason: Measuring glucose levels is important for diabetes management but not directly related to SIADH.

Choice C reason: Using hard candy may help relieve thirst but does not address the underlying issue of fluid retention in SIADH.

Choice D reason:

The correct answer is d) because withholding diuretics and contacting the healthcare provider is necessary to manage the fluid balance in clients with SIADH.

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An adult woman with Grave's disease is admitted with severe dehydration and malnutrition. She is currently restless and refusing to eat. Which action is most important for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client tells the clinic nurse about experiencing burning on urination, and assessment reveals that the client had sexual intercourse four days ago with a person who was a casual acquaintance. Which action should the nurse implement?

Correct Answer is A

Explanation

A client with chronic syndrome of inappropriate antidiuretic hormone (SIADH) reports to the nurse of being constantly thirsty. Which action should the nurse take?

Correct Answer is D

Explanation

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