Patient Data

Exhibits

The nurse has identified the priority problem for the client and now must determine proper care interventions.
Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Provide client teaching

Apply oxygen via nasal cannula.

Ask the client for a list of current medications.

Place the client in Trendelenburg position.

Notify the healthcare provider of the client's need for intubation.

Administer medications as ordered.

Answer and Explanation

Correct Answer : A,B,C,F

A. Client education is also important, focusing on asthma management, the importance of carrying a non-expired inhaler, and avoiding known triggers.

B. Oxygen therapy via nasal cannula should be considered due to the patient's oxygen saturation of 88% on room air, aiming to maintain SpO2 above 94%.

C. Requesting a list of current medications is essential for reviewing potential drug interactions and ensuring comprehensive care.

D. Trendelenburg position is not indicated for this condition and could exacerbate breathing difficulties.

E. While the patient's condition should be closely monitored, the current information does not suggest an immediate need for intubation; however, the healthcare provider should be notified if the patient's condition worsens.

F. Administering medications as ordered is crucial to address the immediate respiratory distress.

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Correct Answer is B

Explanation

A. Obtaining a keyboard designed to limit wrist flexion can help minimize exacerbation of symptoms associated with carpal tunnel syndrome and not Raynaud’s phenomena.

B. Maintaining warmth is crucial for individuals with Raynaud's phenomenon because it helps prevent the onset of symptoms triggered by cold exposure or stress.Keeping the body warm, especially the extremities, helps in minimizing these vasospastic attacks by ensuring that the blood vessels remain dilated, allowing for proper blood flow.

C. While adequate vitamin D intake is important for overall health, it is not specifically indicated as a management strategy for Raynaud's syndrome.

D. Keeping both hands elevated during work breaks may provide some relief, but it may not be practical or feasible for a data entry clerk to maintain this position consistently during work hours.

Correct Answer is ["125"]

Explanation

To calculate the infusion rate in mL/hr, you would convert the total volume of lactated Ringer's IV from liters to milliliters (since there are 1,000 milliliters in a liter, 3 liters is equivalent to 3,000 milliliters) and then divide by the total number of hours over which the infusion is to be administered. In this case, 3,000 mL divided by 24 hours results in an infusion rate of 125 mL/hr.

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Patient Data Exhibits The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who works as a data entry clerk is concerned as to how a recent diagnosis of Raynaud's syndrome is going to affect the client's job performance. Which instruction should the nurse provide this client?

Correct Answer is B

Explanation

A client receives a prescription for 3 liters of lactated Ringer's IV to infuse over 24 hours. How many mL/hr should the nurse program the infusion pump? (Enter numerical value only)

Correct Answer is ["125"]

Explanation

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The nurse is caring for a client that is unconscious and having seizures. Which nursing intervention is most essential in this client's plan of care (POC)

Patient Data Exhibits The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

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Patient Data Exhibits What order(s) should the nurse anticipate being prescribed after an update is reported to the healthcare providers? Select all that apply.

The nurse is caring for a client with chronic pancreatitis who reports persistent gnawing abdominal pain. To help the client manage the pain, which assessment data is most important for the nurse to obtain?

The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?

The nurse is caring for a client who tests positive for the sexually transmitted infection (STI) gonorrhea. The client reports having sex with someone who has many partners. Which response should the nurse provide?

Patient Data

Exhibits

The nurse has identified the priority problem for the client and now must determine proper care interventions.
Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.