Which of the following actions is inappropriate when implementing precautions in a client with hyponatremia?

Encouraging a low-sodium diet

Padding the side rails of the bed

Providing a quiet and calm environment

Having the client use the call light when toileting is needed

Answer and Explanation

The Correct Answer is A

A. Encouraging a low-sodium diet is inappropriate for a client with hyponatremia. Hyponatremia is a condition of low sodium levels in the blood, and the priority in managing this condition is to restore normal sodium levels, not to restrict sodium.
B. Padding the side rails of the bed is appropriate to protect the client from injury, especially if the client is at risk for seizures due to the electrolyte imbalance.
C. Providing a quiet and calm environment is beneficial for a client with hyponatremia, as it can help reduce the risk of seizures or agitation associated with the condition.
D. Having the client use the call light when toileting is needed is a standard precaution to ensure the client’s safety, especially if they are at risk of falls or confusion due to the electrolyte imbalance.

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Correct Answer is A

Explanation

A. 50% Dextrose in Water (D50W) IV push is the most appropriate intervention for a client with a blood glucose level of 30 mg/dL, indicating severe hypoglycemia. The rapid administration of D50W will quickly raise the blood glucose level and help restore consciousness.
B. Insulin Regular IV push would lower the blood glucose level, which is not appropriate in this situation where the client is hypoglycemic.
C. 0.9% sodium chloride infusion is a general fluid replacement solution, but it will not address the client's low blood glucose level.
D. 5% Dextrose continuous IV infusion is typically used for maintenance, but it would not act as quickly as D50W to correct severe hypoglycemia in an unconscious patient.

A. Withhold medication for phantom limb pain as it isn't real pain. B. Keep the residual limb elevated to achieve as close to 90-degree hip flexion as possible. C. Continue using the limb prosthesis even if skin appears irritated. D. Have the client lay prone for 30 minutes, 3-4 times a day.

Correct Answer is D

Explanation

A. Withholding medication for phantom limb pain is inappropriate. Phantom limb pain is a real phenomenon, and it should be managed with appropriate analgesics or other pain management strategies.
B. Keeping the residual limb elevated immediately after surgery is not recommended for prolonged periods as it can lead to contractures. The goal is to avoid excessive flexion at the hip and promote proper positioning.
C. Continuing to use the limb prosthesis when skin is irritated could worsen the irritation and cause skin breakdown. Proper skin care and regular monitoring are essential before using the prosthesis.
D. Laying prone for 30 minutes, 3-4 times a day is an appropriate intervention to prevent hip contractures and encourage proper alignment of the residual limb. This helps to maintain the flexibility of the hip joint and prepares the client for prosthetic fitting.

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Which of the following actions is inappropriate when implementing precautions in a client with hyponatremia?

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Naxlex Comprehensive Predictor Exams

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