A nurse in a provider's office is caring for a client.
Nurses' Notes
3 months ago:
Client seen in provider's office for routine physical. Today:
Client reports dizziness and light-headedness upon standing. Client reports waking up at night to void.
What actions should the nurse take? Select all that apply.
Advise the client to change positions slowly.
Check the client for orthostatic hypotension. Monitor the client for dysrhythmias.
Advise the client to restrict potassium intake.
Advise the client to take the medication before bedtime.
Correct Answer : A,B
A. Advise the client to change positions slowly: The client's symptoms of dizziness and light- headedness upon standing suggest orthostatic hypotension, which can be managed by advising the client to change positions slowly to minimize blood pressure drops upon standing.
B. Check the client for orthostatic hypotension. Monitor the client for dysrhythmias: The client's symptoms, along with the report of waking up at night to void, are suggestive of orthostatic hypotension, a drop in blood pressure upon standing. Checking for orthostatic hypotension and monitoring for dysrhythmias are appropriate nursing actions to assess and manage this condition.
C. Advise the client to restrict potassium intake: Restricting potassium intake is not indicated based on the client's symptoms of dizziness and light-headedness. This action is not relevant to the situation described.
D. Advise the client to take the medication before bedtime: There is no indication in the scenario provided that medication timing is related to the client's symptoms. This action is not relevant to addressing the client's reported symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}
Explanation
Taking the medication with orange juice (a) is advisable as vitamin C can enhance iron absorption
Notifying the provider about black stools is appropriate because it can indicate gastrointestinal bleeding, a potential side effect of ferrous sulfate.
Avoiding antacids while on ferrous sulfate is important because they can decrease the absorption of iron, so this statement demonstrates understanding.
Rinsing the mouth after taking ferrous sulfate can help prevent staining of the teeth, indicating understanding.
Taking the medication on an empty stomach enhances its absorption, so not understanding this instruction suggests a lack of comprehension.
Correct Answer is B
Explanation
A. Metformin is not a contraindication for receiving the shingles vaccine.
B. Methotrexate, an immunosuppressant medication, can interfere with the efficacy of live vaccines such as the shingles vaccine, and it is generally contraindicated to administer live vaccines to individuals taking immunosuppressants.
C. Esomeprazole, a proton pump inhibitor, is not a contraindication for receiving the shingles vaccine.
D. Estrogen is not a contraindication for receiving the shingles vaccine.
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