A client has begun reporting nausea and vomiting.
What would the nurse assess to determine the need for therapy?
Number of times client’s family reports the client is nauseated.
How well the client is eating.
Color and amount of vomit, and frequency of vomiting episodes.
Client’s nutritional status and fluid balance.
The Correct Answer is C
The nurse would assess these factors to determine the need for therapy. Some possible explanations for the other choices are:
Choice A. Number of times client’s family reports the client is nauseated.
This is not a reliable indicator of the severity or cause of nausea and vomiting.
The nurse should assess the client directly and not rely on the family’s reports.
Choice B. How well the client is eating.
This is not a specific or objective measure of nausea and vomiting.
The client may have other reasons for not eating well, such as loss of appetite, taste changes, or pain.
The nurse should also monitor the client’s weight, hydration status, and electrolyte levels.
Choice D. Client’s nutritional status and fluid balance.
These are important aspects of the client’s overall health, but they are not directly related to nausea and vomiting.
The nurse should assess these factors as part of the comprehensive care plan, but they are not sufficient to determine the need for therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Guaifenesin is an expectorant that helps thin and loosen mucus in the lungs, making it easier to cough up the sputum. Some possible explanations for the other choices are:
Choice A. Benzonatate is wrong because benzonatate is an antitussive that suppresses the cough reflex by numbing the throat and lungs.
It does not help with sputum production or clearance.
Choice B. Dextromethorphan is wrong because dextromethorphan is also an antitussive that acts on the brain to reduce the urge to cough.
It does not affect the mucus or bronchial secretions.
Choice C. Hydrocodone is wrong because hydrocodone is a narcotic antitussive that works by binding to opioid receptors in the brain and spinal cord, blocking pain signals and decreasing cough.
It can cause sedation, respiratory depression, and dependence, and is not indicated for bronchitis.
Normal ranges for sputum production vary depending on the individual and the cause of the cough, but generally range from 10 to 100 mL per day.
Excessive or abnormal sputum may indicate an infection, inflammation, or obstruction of the airways.
Correct Answer is D
Explanation
Glargine is a long-acting insulin that can provide a steady level of insulin for up to 24 hours. This would be suitable for a client who does not want to administer insulin on the plane, as they can take it once a day at the same time.
Choice A. Glulisine is wrong because glulisine is a rapid-acting insulin that starts working within 15 minutes and lasts for 3 to 4 hours.
This would require frequent injections and monitoring of blood glucose levels.
Choice B. Lispro is wrong because lispro is also a rapid-acting insulin that starts working within 15 minutes and lasts for 3 to 4 hours.
This would also require frequent injections and monitoring of blood glucose levels.
Choice C. Aspart is wrong because aspart is another rapid-acting insulin that starts working within 15 minutes and lasts for 3 to 4 hours.
This would also require frequent injections and monitoring of blood glucose levels.
Normal ranges for blood glucose levels are 70 to 130 mg/dL before meals and less than 180 mg/dL two hours after meals.
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