Which instruction should the nurse include in the discharge teaching plan for an adult client with hypernatremia?
Use salt tablets after strenuous exercise.
Monitor daily urine output volume.
Drink plenty of water whenever thirsty.
Review food labels for sodium content.
Review food labels for sodium content.
The Correct Answer is D
D. The correct instruction to include in a discharge teaching plan for an adult client with hypernatremia is to review food labels for sodium content. Hypernatremia is a condition characterized by high levels of sodium in the blood, and it is often due to fluid loss rather than excessive sodium intake.
A. Hypernatremia is characterized by elevated levels of sodium in the blood, and reducing sodium intake is typically part of the treatment plan. Instructing the client to use salt tablets would exacerbate the hypernatremia and could lead to further complications.
B. This instruction is not directly related to managing hypernatremia. While monitoring urine output is important for assessing hydration status and kidney function, it may not specifically address the underlying cause of hypernatremia.
C. Hypernatremia is often caused by dehydration or inadequate water intake, leading to elevated sodium levels in the blood. Therefore, hydrating is an important instruction but not the most important.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"B"}}
Explanation
A. Rhonchi are abnormal breath sounds that indicate the presence of mucus or fluid in the airways. Finding rhonchi in the right lung suggests the presence of respiratory congestion or obstruction, which may indicate ineffective treatment or ongoing respiratory issues.
B. Symmetric chest expansion indicates equal and adequate movement of both sides of the chest during inhalation. This finding suggests that there are no restrictions or abnormalities in the chest wall or lung tissue, which is indicative of effective treatment.
C. Oxygen saturation greater than 94% indicates adequate oxygenation of the blood, which is a positive indicator of effective treatment, particularly in clients with respiratory issues such as pneumonia or COPD.
D. A PaCO2 level of 55 mm Hg indicates hypercapnia, which is an elevated level of carbon dioxide in the blood. This finding suggests inadequate ventilation or respiratory failure, indicating ineffective treatment.
E. The ability to ambulate without experiencing shortness of breath suggests improved respiratory function and effective treatment, as it indicates adequate oxygenation and ventilation.
F. Diminished breath sounds suggest reduced airflow or lung volume in the affected area. This finding may indicate ongoing respiratory issues or incomplete resolution of the condition, suggesting ineffective treatment.
Correct Answer is A
Explanation
A Preventing esophageal reflux is essential in managing symptoms associated with a direct hiatal hernia. Nursing interventions may include promoting proper positioning (elevating the head of the bed), encouraging smaller, more frequent meals, avoiding trigger foods, and administering medications as prescribed to reduce acid reflux.
B Promoting intestinal peristalsis may be beneficial in certain gastrointestinal conditions, such as constipation but it is not directly related to the management of a direct hiatal hernia.
C Promoting effective swallowing is important for overall swallowing function and preventing aspiration in some cases, it may not directly address the symptoms or complications associated with a direct hiatal hernia.
D Maintaining intact oral mucosa is important for oral health and preventing complications such as oral mucositis, but it is not directly related to the management of a direct hiatal hernia.
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