The nurse understands that the rationale(s) for clients receiving intravenous (IV) therapy is/are to: (SELECT ALL THAT APPLY)

compensate for an ongoing problem affecting other fluid or electrolytes.

Increase urine specific gravity to 1.045.

move fluid into an area that is physiologically unavailable.

correct imbalance in fluid and electrolytes.

expand intravascular volume.

Answer and Explanation

Correct Answer : A,D,E

Choice A rationale: Compensating for an ongoing problem affecting other fluid or electrolytes is a common rationale for IV therapy.

Choice B rationale: Increasing urine specific gravity to 1.045 is not a typical goal for IV therapy. IV therapy would decrease the urine specific gravity by diluting the urine with fluids.

Choice C rationale: Moving fluid into an area that is physiologically unavailable is not a primary goal of IV therapy. Physiologically unavailable areas are those that are separated from the rest of the body by a membrane or barrier, such as the cerebrospinal fluid, the intraocular fluid, or the pleural fluid. IV therapy does not cross these barriers and only affects the intravascular and interstitial spaces.

Choice D rationale: Correcting imbalance in fluid and electrolytes is a primary goal of IV therapy.

Choice E rationale: Expanding intravascular volume is a common goal of IV therapy, especially in cases of dehydration or hypovolemia.

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Correct Answer is D

Explanation

Choice A rationale: Norming is characterized by the development of group cohesion and establishment of norms, not necessarily high-level problem-solving.

Choice B rationale: Storming is marked by conflict and tension within the group, not optimal problem-solving.

Choice C rationale: Forming is the initial stage where members get to know each other; it does not represent a highly functioning team.

Choice D rationale: Performing is the stage where the group is functioning at its highest level, demonstrating effective problem-solving and productivity.

A. Use a small gauge needle B. Use the Z-track method C. Administer at a 45-degree angle D. Apply ice to the injection site

Correct Answer is B

Explanation

Choice A rationale: Using a small gauge needle may reduce pain but does not specifically address tissue irritation.

Choice B rationale: The Z-track method is used to reduce irritation and prevent leakage of irritating medications into the subcutaneous tissues.

Choice C rationale: Administering at a 45-degree angle is a common angle for intramuscular injections but does not specifically address tissue irritation.

Choice D rationale: Applying ice to the injection site is not a standard practice for reducing tissue irritation with intramuscular injections.

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The nurse understands that the rationale(s) for clients receiving intravenous (IV) therapy is/are to: (SELECT ALL THAT APPLY)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A group that has transformed itself from a collection of individuals into a productive, problem-solving highly functioning team would be functioning in which stage of group development?

Correct Answer is D

Explanation

The nurse must give a client an intramuscular injection of a medication which is very irritating to the subcutaneous tissues. To attempt to reduce irritation of the tissues, which action should the nurse take?

Correct Answer is B

Explanation

The nurse is aware that a common cause of under delegation in client care is:

The nurse is to administer a volume of 2 mL intramuscularly (IM) to a 150-pound client. Assuming that there are no skin problems, which is the preferred site for the injection?

A postoperative client has an abdominal incision and a Penrose drain. Both are covered with an abdominal dressing. Which is an important nursing action associated with caring for a client with a Penrose drain?

The nurse knows that teaching about the use of the spirometer incentive is effective when the client seals the lips around the mouthpiece and:

A nurse is caring for a client being treated for hypernatremia. Which of the following are appropriate nursing interventions? (SELECT ALL THAT APPLY)

A nurse receives an order for blood, urine, stool and nasal cultures on a client with a high fever. Which prefix describes this order?

In order to minimize discomfort when giving an injection to a client, the nurse should:

An alert, competent client refuses to take her antihypertensive medication. The nurse has explained why the medication is important and the client states that she understands but doesn't want to take the medication. What is the best nursing action?