A nurse is caring for a client who is dehydrated and receiving IV fluid replacement. The nurse should identify that which of the following findings indicates the treatment has been effective?
Increased heart rate
Excessive thirst
Moist oral mucous membranes
Decreased blood pressure
The Correct Answer is C
A. An increased heart rate can be a sign of dehydration and would not indicate that IV fluid replacement has been effective.
B. Excessive thirst is a symptom of dehydration and would not indicate that IV fluid replacement has been effective.
C. Moist oral mucous membranes indicate improved hydration status and are a positive response to IV fluid replacement.
D. Decreased blood pressure is a sign of dehydration and would not indicate that IV fluid replacement has been effective.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. To assess compatibility of the verapamil with newly ordered medications: Verapamil is a calcium channel blocker used to treat hypertension, angina, and arrhythmias. It has potential interactions with many other medications due to its effects on cardiac conduction and blood
pressure. Therefore, consulting the pharmacist is important to assess compatibility and potential drug interactions when new medications are prescribed.
B. To request a change in the dosage of the verapamil: Changing the dosage of verapamil may require a healthcare provider's order rather than consultation with a pharmacist.
C. To verify the frequency of administration of the verapamil: The frequency of administration of verapamil is typically determined by the healthcare provider and documented in the prescription. The pharmacist's role may involve dispensing the medication as prescribed but not verifying the frequency unless there are discrepancies.
D. To report the client's refusal to take the verapamil: Reporting the client's refusal to take the medication should be communicated to the healthcare provider for further assessment and
intervention. The pharmacist's role is primarily related to medication dispensing and ensuring appropriate use rather than addressing client refusals.
Correct Answer is C
Explanation
A.While medication verification is important, this is not specific to administering an intermittent IV bolus. It is standard practice for high-alert medications, not routine antibiotics.
B. Flushing the IV site with sterile water prior to connecting the secondary infusion is not standard practice. Normal saline is typically used to maintain patency, but it is not necessary before connecting the secondary infusion.
C.To administer a secondary infusion (e.g., antibiotic), the secondary bag must be hung higher than the primary infusion. This allows gravity to prioritize the secondary infusion through the Y-site.
D. Disconnecting the primary IV infusion to connect the secondary infusion is not correct. The secondary infusion should connect to the primary line without disrupting the ongoing infusion unless otherwise indicated.
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