The nurse assesses that a client who is disoriented drank eight glasses of water in two hours and is continuing to drink excessive amounts of water. Because the nurse is concerned about water intoxication, which laboratory value should the nurse monitor?

White blood cell count.

Serum sodium levels.

Serum potassium levels.

Creatinine clearance.

Answer and Explanation

The Correct Answer is B

A. White blood cell count is related to immune function and is not directly affected by water intoxication.
B. Serum sodium levels are the primary concern in cases of water intoxication. Excessive water intake can dilute the sodium in the blood, leading to hyponatremia, which can cause confusion, seizures, and other serious complications.
C. While serum potassium levels are important for overall electrolyte balance, they are not as immediately affected by water intoxication as sodium levels are.
D. Creatinine clearance is a measure of kidney function and does not directly relate to the immediate risks associated with water intoxication.

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Correct Answer is D

Explanation

A. Transporting the client without protective equipment would not comply with droplet precaution protocols and could pose a risk of infection to others.
B. Placing goggles over the eyeglasses is not necessary if a surgical mask can be properly fitted, as the mask itself provides the needed protection for droplet precautions.
C. A fitted respirator-style mask is typically not required for droplet precautions; a surgical mask is sufficient.
D. Securing a surgical face mask over the bridge of the client's nose just below the eyeglasses ensures that the mask is properly fitted, providing adequate protection while allowing the client to wear their eyeglasses comfortably. This approach adheres to droplet precaution protocols.

A. Include caregiver in discussion of pain relief strategies. B. Encourage the client to talk about her fear related to pain. C. Explain that analgesics will be given whenever needed. D. Provide therapeutic touch along with comfort and support.

Correct Answer is B

Explanation

A. Including the caregiver in discussions about pain relief strategies is important, but addressing the client’s immediate concerns and fears should come first.
B. Encouraging the client to talk about her fear related to pain allows the nurse to understand her specific concerns and provide personalized reassurance and support. Addressing the client’s emotional needs is crucial in hospice care.
C. Explaining that analgesics will be given as needed is important for reassurance but may not fully address the client’s fear or allow for an open discussion about her concerns.
D. Providing therapeutic touch and comfort is supportive but does not directly address the client’s fear. Engaging in a conversation about her specific fears allows for more targeted and effective reassurance.

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The nurse assesses that a client who is disoriented drank eight glasses of water in two hours and is continuing to drink excessive amounts of water. Because the nurse is concerned about water intoxication, which laboratory value should the nurse monitor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing a client placed on droplet precautions for transport from the client's room to another department. The client wears eyeglasses and refuses to remove them while being transported. Which action should the nurse take?

Correct Answer is D

Explanation

A female client who is receiving hospice care in her home expresses fear that dying will be painful. Which action should the nurse take first?

Correct Answer is B

Explanation

The nurse plans to encourage a group of young adult clients to engage in problem-solving strategies. Which action is most useful for the nurse to include during the teaching session?

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Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.