Which intervention should the nurse implement to maintain adequate hydration in an immobile patient?

Offering fluids at room temperature.

Limiting fluid intake to prevent incontinence.

Providing a straw for easier drinking.

Administering intravenous fluids continuously.

Answer and Explanation

The Correct Answer is A

Offering fluids at room temperature can enhance the patient's comfort and promote adequate hydration in immobile patients.

Incorrect choices:

b. Limiting fluid intake to prevent incontinence is not appropriate as it can lead to dehydration. Adequate hydration should be maintained, and measures to manage incontinence should be implemented separately.

c. Providing a straw for easier drinking can facilitate fluid intake, but it may not be suitable for all patients or situations. Individualized assessment and patient preference should be considered.

d. Continuous intravenous fluids may not be necessary for all immobile patients and should be based on specific indications determined by the healthcare provider. Oral intake should be encouraged unless contraindicated.

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Correct Answer is B

Explanation

Assisting the patient with passive range of motion exercises promotes joint mobility and prevents contractures and muscle atrophy when the patient is unable to move independently.

Incorrect choices: a. Encouraging the patient to remain in bed perpetuates immobility and can lead to further complications such as deconditioning and reduced muscle strength.

c. Restricting the patient's movement can worsen immobility-related complications and increase the risk of falls. Appropriate interventions should be implemented to facilitate safe mobility.

d. Restraints should be avoided as much as possible and only used as a last resort to ensure patient safety. Restraints do not promote mobility and can have negative physical and psychological effects.

A. Administering oxygen therapy. B. Assisting with incentive spirometry exercises. C. Encouraging deep breathing and coughing techniques. D. Administering prophylactic antibiotics.

Correct Answer is C

Explanation

Encouraging deep breathing and coughing techniques helps prevent respiratory complications such as atelectasis and pneumonia in patients with impaired mobility.

Incorrect choices:

a. Administering oxygen therapy may be indicated in some cases, but it does not directly address the prevention of respiratory complications associated with impaired mobility.

b. Incentive spirometry exercises are useful for promoting lung expansion and preventing atelectasis, but they are not the highest priority intervention for preventing respiratory complications.

d. Prophylactic antibiotics are not routinely administered to all patients with impaired mobility. Their use should be based on specific indications determined by the healthcare provider.

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Which intervention should the nurse implement to maintain adequate hydration in an immobile patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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