A nurse is caring for a client in the clinic.
The nurse anticipates which of the following orders from the provider based on the suspected diagnosis? (Select all that apply)
IV antibiotics
Urinalysis
Chest x-ray
Chest tube placement
Admit to inpatient
Airborne precautions
Draw an STI lab panel
Complete blood count
Correct Answer : A,C,E,H
The nurse anticipates the following orders from the provider based on the suspected diagnosis:
- A. IV antibiotics: To treat the suspected infection.
- C. Chest x-ray: To assess the lungs for signs of infection, such as pneumonia.
- E. Admit to inpatient: The client's worsening condition and need for aggressive treatment warrant hospitalization.
- H. Complete blood count: To assess the client's overall health status and identify any abnormalities, such as anemia or infection.
Rationale:
- B. Urinalysis: While a urinalysis can be helpful in assessing for urinary tract infections, it is not a priority in this case.
- D. Chest tube placement: This is not indicated unless the client develops a pleural effusion or pneumothorax.
- F. Airborne precautions: This is not necessary for the client's current condition.
- G. Draw an STI lab panel: While this may be relevant for the client's overall health, it is not a priority at this time, especially given the client's acute presentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Increasing the infusion rate may exacerbate the patient's symptoms and does not address the potential toxicity from the furosemide.
B. Normal potassium levels indicate that potassium supplementation is unnecessary and does not address the dizziness and ringing in the ears, which could suggest ototoxicity from furosemide.
C. While reassurance can help, the patient's symptoms indicate a potential adverse reaction to the medication that should not be ignored.
D. Stopping the furosemide infusion and notifying the provider is the most appropriate action due to the risk of ototoxicity and the need for further evaluation of the patient's symptoms.
Correct Answer is B
Explanation
A. Flushing of the skin is not typical in hypovolemic shock; rather, the skin is usually cool and clammy due to vasoconstriction.
B. Oliguria, or decreased urine output, is expected in hypovolemic shock as the kidneys receive less blood flow, leading to reduced urine production.
C. Bradypnea is not a common finding in hypovolemic shock; instead, tachypnea (increased respiratory rate) is typically observed due to compensatory mechanisms for hypoxia and acidosis.
D. Hypertension is not expected in hypovolemic shock; instead, the client typically presents with hypotension due to decreased blood volume and pressure.
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