A client diagnosed with renal calculi is admitted to the medical unit with renal colic. Which interventions should the nurse implement the first?
Assess the client's pain and related complications
Monitor the client's urinary output
Use a safety gait belt when ambulating the client
Increase the client's oral fluid intake
The Correct Answer is A
A. Pain assessment and management are a priority in renal colic due to the severe discomfort it causes, and prompt treatment is necessary.
B. Monitoring urinary output is important but is secondary to immediate pain management.
C. Safety during ambulation is necessary, but assessing and managing pain takes precedence in an acute setting.
D. Increasing fluid intake can help flush out stones but is typically addressed after pain management.
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Related Questions
Correct Answer is B
Explanation
A. Checking urine for ketones is more relevant in DKA, not HHNS, as HHNS typically does not involve ketone production.
B. When blood glucose drops significantly, insulin infusion rates are usually decreased to prevent hypoglycemia and a rapid fall in glucose levels.
C. Increasing the insulin drip could cause hypoglycemia, as the client’s glucose is already decreasing.
D. A regular meal can be given when the client’s glucose levels are more stable and controlled, but meal timing should be coordinated with insulin adjustments.
Correct Answer is B
Explanation
A. Hypocalcemia is associated with hyperactive, not hypoactive, deep tendon reflexes.
B. Tingling of the extremities, known as paresthesia, is a common symptom of hypocalcemia, which can occur after thyroidectomy due to potential damage or removal of the parathyroid glands.
C. Constipation is more commonly associated with hypercalcemia.
D. Hypocalcemia typically presents with a prolonged, not shortened, QT interval.
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