An older resident of an extended care facility has recurrent urinary tract infections. The nursing care plan includes the goal, "Increase daily intake of fluids." Which nursing intervention is most useful in assisting the resident to meet this goal?
Record the client's intake and output every shift.
Offer a glass of fluid every hour while awake.
Increase fluids provided with the client's meals.
Maintain a full pitcher of water at the bedside.
The Correct Answer is B
A. Record the client's intake and output every shift: While important for monitoring fluid balance, this intervention does not directly facilitate increased fluid intake.
B. Offer a glass of fluid every hour while awake: This intervention ensures regular and frequent opportunities for the resident to consume fluids, which can help increase overall intake.
C. Increase fluids provided with the client's meals: While this may help increase fluid intake, relying solely on meals may not be sufficient, especially if the resident does not finish their meals.
D. Maintain a full pitcher of water at the bedside: While having water readily available is important, relying solely on this may not ensure regular intake throughout the day.
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Related Questions
Correct Answer is C
Explanation
A. Evaluating upper and lower extremities for perfusion, pulse volume, and pitting edema is important in assessing peripheral perfusion, but the priority action in this scenario is to initiate treatment for a suspected myocardial infarction.
B. Placing an indwelling urinary catheter and instituting strict intake and output measurements is not the priority action in this scenario. The client's symptoms and history suggest a cardiac event requiring immediate intervention.
C. Administering four 81 mg aspirin tablets (324 mg total) as soon as possible is the priority action for a client presenting with chest pain suggestive of acute coronary syndrome. Aspirin helps to prevent platelet aggregation and reduce the risk of clot formation.
D. Securing client consent for coronary angiography and percutaneous coronary intervention may be necessary but is not the immediate priority. The client needs immediate treatment to alleviate symptoms and stabilize the condition.
Correct Answer is B
Explanation
A. Client's healthcare power of attorney: While important, this information may not be
immediately relevant to the client's current condition and the reason for contacting the healthcare provider.
B. Increasing confusion of the client: This information indicates a change in the client's status and is the most pertinent to the client's current condition, warranting immediate attention.
C. Fall at home as reason for admission: While important for background information, the reason for admission is already known, and the focus of the communication should be on the client's current status.
D. Currently prescribed medications: This information is important but may not be the priority when reporting a change in the client's condition.
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