A nurse hangs a bag of dextrose 5% in water 1,000 mL at 0800 to run at 125 mL/hr. At 1200, the nurse notices that the client's IV bag is empty. Which of the following interventions should the nurse take first?
Notify the primary care provider.
Calculate the infused volume.
Complete an incident report.
Assess the client's vital signs.
The Correct Answer is D
The nurse should assess the client's vital signs first to determine if there are any signs of fluid overload, such as hypertension, edema, crackles, or dyspnea. The nurse should then notify the primary care provider.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The nurse should include in report type of transmission-based precautions in place for client who has shingles, which is contact precautions. This information is essential for preventing spread of infection to other clients and staff members. The client's background health history, number of visitors during shift, and times for routine vital sign measurements are not specific or relevant information for this client's condition and do not need to be included in report.
Correct Answer is A
Explanation
The rationale for this answer is that a back massage is a non-pharmacological intervention that can help reduce pain by promoting relaxation and increasing blood circulation. It also shows respect for the client's preference and offers a choice of alternative therapy.
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