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A nurse is caring for a client in the emergency room.

Exhibits
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Rationale:

  • Potential Condition: The client presents with jaundice, ascites, abdominal distention, confusion, and abnormal liver function tests (elevated AST, ALT, and bilirubin, with low albumin), consistent with cirrhosis and fluid volume excess.
  • Actions to Take:
    • Administer diuretics (such as spironolactone or furosemide) to reduce fluid retention and help manage ascites.
    • Monitor fluid intake and output to evaluate fluid balance and effectiveness of diuretic therapy.
  • Parameters to Monitor:
    • Blood pressure is important because hypotension is present and can worsen with fluid shifts and diuretic therapy.
    • Abdominal girth is monitored to track the progression or reduction of ascites.


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Related Questions

Correct Answer is D

Explanation

Rationale:
A. Celery and other high-fiber, coarse vegetables should be avoided during an acute diverticulitis episode because they can irritate the inflamed colon.
B. Green peas are high in fiber and may worsen symptoms during acute inflammation.
C. Green salad is high in fiber and not recommended during an acute flare.
D. Grilled chicken breast with white rice is low in fiber, easily digestible, and gentle on the gastrointestinal tract, making it appropriate for a client with acute diverticulitis.

Correct Answer is ["15"]

Explanation

Rationale:
Desired dose = 15 mg
Available concentration = 5 mg per 5 mL = 1 mg/mL
Volume needed = Desired dose ÷ Concentration = 15 mg ÷ 1 mg/mL = 15 mL
Rounded to nearest whole number = 15 mL

Final Answer: 15 mL

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