A client on a mechanical soft diet is experiencing constipation and asks the nurse for a glass of prune juice. After auscultating decreased bowel sounds, which action should the nurse implement?

Restrict oral fluid intake.

Offer to warm the prune juice.

Advance to a regular diet.

Initiate bowel training protocol.

Answer and Explanation

The Correct Answer is D

A. Restrict oral fluid intake is not appropriate in this situation. Decreased bowel sounds and constipation may indicate a need for hydration, not restriction of fluids. Fluids are essential to help prevent and alleviate constipation.

B. Offer to warm the prune juice may be helpful in some cases to encourage the client to drink, but it does not address the underlying issue of constipation and decreased bowel sounds. A more comprehensive intervention, such as bowel training, is needed.

C. Advance to a regular diet may not be appropriate without assessing the client's tolerance for additional food types. The client is on a mechanical soft diet, which may already be sufficient. Advancing to a regular diet could potentially exacerbate the constipation.

D. Initiate bowel training protocol is the most appropriate action. Bowel training is designed to help manage constipation and promote regular bowel movements. This may include dietary adjustments, increased fluid intake, and other measures such as scheduled toileting.

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Correct Answer is B

Explanation

A. Clamping the urinary catheter prior to the collection is typically done with clean hands, as the nurse is preparing the catheter for specimen collection. Gloves are not required for this step, as long as proper hand hygiene is performed before and after.

B. Using the syringe to remove the specimen from the catheter is the correct time for the nurse to wear gloves. This step involves direct contact with potentially contaminated urine, and gloves are necessary to maintain infection control and protect the nurse from exposure to bodily fluids.

C. Recording the output on the flowsheet in the client's room does not require gloves, as this step does not involve direct contact with the urine. The nurse should perform proper hand hygiene before and after documenting the output.

D. Transporting the urine specimen to the laboratory does not require gloves, as the specimen is contained in a biohazard bag. Gloves are typically worn during the collection process, but transporting a properly sealed specimen does not require additional protection.

Correct Answer is ["0.5"]

Explanation

· Convert grams to milligrams: 1 gram = 1000 mg

· Determine the concentration: The vial contains 1000 mg of streptomycin in 2.5 mL of solution.

· Set up a proportion: (Desired dose / Concentration) Volume = Amount to administer

(200 mg / 1000 mg) x 2.5 mL = X mL

· Solve for X: 0.2 x 2.5 mL = 0.5 mL

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A client on a mechanical soft diet is experiencing constipation and asks the nurse for a glass of prune juice. After auscultating decreased bowel sounds, which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse uses a sterile syringe to obtain a urine specimen from a client's indwelling urinary catheter. After placing the specimen in a biohazard bag, the nurse transports the specimen to the laboratory. During which part of this procedure should the nurse wear gloves?

Correct Answer is B

Explanation

The healthcare provider prescribes streptomycin 200 mg intramusculary every 12 hours. The vial is labeled, "Streptomycin 1 gram/2.5 mL". How many milliliters should the nurse administer? (Enter numerical value only. (If rounding is required, round to the nearest tenth.)

Correct Answer is ["0.5"]

Explanation

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