A nurse is caring for a client.

Exhibits

Which of the following actions should the nurse take? (Select all that apply.)

Wear a mask when caring for the client.

Place the client in private room.

Encourage the client to increase fluid intake.

Place the client on contact precautions.

Prepare to administer an antibiotic to the client.

Answer and Explanation

Correct Answer : A,B,C

A. Wear a mask when caring for the client: This is an important action to prevent the spread of influenza, which is transmitted via respiratory droplets. Wearing a mask helps protect both the healthcare provider and other patients from potential exposure to the virus, especially in the early stages of the disease when the client is most contagious.
B. Place the client in a private room: This action is recommended to minimize the risk of transmitting the influenza virus to other patients. Isolating the client in a private room can help control the spread of infection, making it a necessary measure in this situation.
C. Encourage the client to increase fluid intake: Adequate hydration is essential for clients with influenza to help alleviate fever and maintain overall health. Increasing fluid intake supports the immune system and helps prevent complications such as dehydration, so encouraging the client to drink more fluids is appropriate.
D. Place the client on contact precautions: While contact precautions are essential for preventing the spread of infections transmitted by direct contact, they are not specifically necessary for influenza, which is primarily airborne and droplet transmitted. Standard precautions, including droplet precautions, are sufficient for managing a client with influenza.
E. Prepare to administer an antibiotic to the client: This action is not appropriate because influenza is a viral infection, and antibiotics are ineffective against viruses. Treatment for influenza typically involves antiviral medications if indicated, supportive care, and symptom management rather than antibiotics. Therefore, this option should not be included in the actions the nurse takes.

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Correct Answer is ["15"]

Explanation

Formula:

Volume to administer (mL) = (Desired dose (mEq) / Available concentration (mEq/mL))

Desired dose = (40 mEq / 2 doses)

=20mEq

Available concentration = 6.7 mEq / 5 mL

Calculate the concentration per mL:

6.7 mEq / 5 mL = 1.34 mEq/mL

Volume to administer = 20 mEq / 1.34 mEq/mL

= 14.925... mL

Round to the nearest whole number:

Volume to administer = 15 mL

A. Initiate a weight-based continuous heparin infusion. B. Prepare client for a chest tube insertion. C. Administer an analgesic. D. Insert an indwelling urinary catheter. E. Initiate supplemental oxygen.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

Initiate a weight-based continuous heparin infusion: Continuous heparin infusion is typically used for managing or preventing thromboembolic events, such as deep vein thrombosis or pulmonary embolism. In this scenario, the primary concern is a pneumothorax, and there is no indication that the client requires anticoagulation therapy at this time.

Prepare client for a chest tube insertion: Given the diagnosis of a right upper lobe pneumothorax, preparing the client for chest tube insertion is essential. A chest tube is necessary to evacuate air from the pleural space, restore negative pressure, and allow for lung re-expansion, which is critical in managing a pneumothorax.

Administer an analgesic: Administering an analgesic is essential to help manage the client's pain, which is likely due to the pneumothorax. Effective pain management can help reduce anxiety and improve the client's ability to breathe comfortably.

Insert an indwelling urinary catheter: Inserting an indwelling urinary catheter is not essential in this situation. The client has voided a sufficient amount of clear yellow urine, and there is no indication of urinary retention or other complications that would require catheterization.

Initiate supplemental oxygen: Initiating supplemental oxygen is essential for the client, who is exhibiting hypoxia with a pulse oximetry reading of 85% on room air. Providing supplemental oxygen will help improve oxygenation and alleviate respiratory distress.

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A nurse is caring for a client. Exhibits Which of the following actions should the nurse take? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer potassium chloride elixir 40 mEq divided into 2 equal doses every 12 hr. Available is 6.7 mEq/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["15"]

Explanation

A nurse is caring for a client. Exhibits For each potential nursing action, click to specify if the action is essential, nonessential, or contraindicated for the client.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

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A nurse is caring for a client.

Exhibits

Which of the following actions should the nurse take? (Select all that apply.)