A client who is hypotensive is receiving dopamine, an adrenergic agonist, IV at the rate of 6 mcg/kg/min. Which intervention should the nurse implement while administering this medication?
Initiate seizure precautions.
Monitor serum potassium frequently.
Assess pupillary response to light hourly.
Measure urinary output every hour.
The Correct Answer is D
A. Initiate seizure precautions: Dopamine administration does not typically require seizure
precautions. The focus should be on monitoring for adverse effects related to blood pressure and urinary output.
B. Monitor serum potassium frequently: While electrolyte imbalances can occur with dopamine administration, the priority is to monitor urinary output as dopamine affects renal perfusion and urine output.
C. Assess pupillary response to light hourly: Monitoring pupillary response is important in some situations, but it's not the primary concern with dopamine administration.
D. Measure urinary output every hour: Correct! Dopamine is administered to improve renal perfusion and increase urine output in hypotensive patients. Monitoring urinary output every
hour is essential to assess the effectiveness of dopamine therapy and detect any signs of renal dysfunction or worsening hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Replacing the IV site with a smaller gauge does not address the issue of the client picking at the dressing and tape. It is important to address the primary concern, which is the integrity of the abdominal incision dressing.
B. Applying wrist restraints should be avoided unless absolutely necessary due to the risk of physical and psychological harm to the client. It is not the first-line intervention for addressing dressing and tape disruption.
C. Leaving the lights on in the room at night may help reduce confusion in some clients with dementia but does not address the immediate issue of the disrupted abdominal dressing and IV site.
D. Redressing the abdominal incision is the priority intervention to maintain the integrity of the surgical site and prevent infection. It also addresses the issue of the client picking at the dressing and tape, which could lead to further complications.
Correct Answer is C
Explanation
A. A 16-year-old client diagnosed with major depression who refuses to participate in group:
While refusal to participate may warrant assessment and intervention, it does not indicate immediate danger or escalation.
B. A 17-year-old client diagnosed with bipolar disorder who is pacing around the lobby: Pacing behavior may indicate anxiety or agitation, but it does not necessarily require immediate attention unless there are signs of escalating behavior or safety concerns.
C. An 18-year-old client with antisocial behavior who is being yelled at by other clients: Correct! The client with antisocial behavior being yelled at by other clients indicates a potential conflict or safety issue that requires immediate intervention to prevent escalation or harm to the client or others.
D. A 14-year-old client with anorexia nervosa who is refusing to eat the evening snack: Refusal to eat is concerning in a client with anorexia nervosa, but it does not pose an immediate threat to safety compared to the situation involving potential conflict or aggression.
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