A nurse is caring for a client who has meningitis, a temperature of 39.7° C (103.5° F) and is prescribed a hypothermia blanket.
While using this therapy, the nurse should know that the client must carefully be observed for which of the following complications?
Dehydration.
Shivering.
Seizures.
Burns.
The Correct Answer is B
The correct answer is choice B: Shivering.
Choice A rationale: Dehydration is a risk associated with high fever and infections like meningitis, but it is not a direct complication of using a hypothermia blanket.
Choice B rationale: Shivering is a complication of using a hypothermia blanket, as the body may react to the induced cooling by shivering, which can raise body temperature and counteract the blanket's cooling effect.
Choice C rationale: Seizures can occur in meningitis cases, but they are not specifically a complication of using a hypothermia blanket.
Choice D rationale: Burns are not a typical complication of using a hypothermia blanket when it is used as directed and monitored appropriately. However, skin irritation may occur in some cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Positive Kernig’s sign is a clinical sign of meningitis, not specifically increased ICP12.
Choice B rationale:
Photophobia, or light sensitivity, is a symptom of meningitis but does not specifically indicate increased ICP12.
Choice C rationale:
Nuchal rigidity, or neck stiffness, is another symptom of meningitis, not a specific indicator of increased ICP12.
Choice D rationale:
Restlessness can be a sign of increased ICP as it may indicate changes in mental status, a key symptom of increased ICP12.
Correct Answer is C
Explanation
The correct answer is Choice C: "I will make a list of my favorite beverages."
Choice A rationale: Stating that they will put beverages in large containers to give the appearance of drinking a lot demonstrates a lack of understanding of fluid restriction guidelines. It focuses on the appearance rather than the actual fluid intake limitation. This statement does not reflect an understanding of the need to limit fluids in acute kidney disease.
Choice B rationale: Consuming most fluids during the evening is not recommended for clients with acute kidney disease as it may lead to discomfort, nighttime urination, and fluid overload. This statement does not demonstrate an understanding of the importance of spreading fluid intake throughout the day.
Choice C rationale: Making a list of favorite beverages indicates the client's understanding of fluid restrictions. This approach can help the client prioritize their preferred beverages while staying within their prescribed fluid allowance. It shows that the client is aware of the need to be selective in their fluid intake.
Choice D rationale: Although avoiding ice cream is an appropriate action due to its contribution to fluid intake, this statement alone does not necessarily indicate a comprehensive understanding of fluid restrictions. The client must also be aware of the importance of monitoring all sources of fluid intake, including other foods and beverages.
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