A nurse is caring for a client with a body temperature of 38°C (100.4°F). Which of the following interventions should the nurse prioritize?
Administer antipyretic medication as prescribed.
Encourage fluid intake to prevent dehydration.
Monitor vital signs every 4 hours.
Apply a cooling blanket to reduce fever.
The Correct Answer is A
Choice A rationale
Administering antipyretic medication as prescribed is a priority intervention for a client with a body temperature of 38°C (100.4°F). Antipyretics help reduce fever and provide comfort to the patient. They work by inhibiting the production of prostaglandins, which are involved in the fever response.
Choice B rationale
Encouraging fluid intake to prevent dehydration is also important, but it is not the priority intervention. Adequate hydration helps maintain fluid balance and supports the body’s ability to regulate temperature.
Choice C rationale
Monitoring vital signs every 4 hours is essential for assessing the patient’s condition, but it is not an intervention that directly addresses the fever. It helps track the patient’s response to treatment and detect any changes in their condition.
Choice D rationale
Applying a cooling blanket to reduce fever can be effective, but it is typically used when antipyretic medications are not sufficient or contraindicated. Cooling measures help lower body temperature through conduction and evaporation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Increased thirst is a symptom of hyperglycemia, not hypoglycemia. It occurs when high blood sugar levels cause dehydration.
Choice B rationale
Increased appetite can occur in hypoglycemia but is not as specific as other symptoms like slurred speech.
Choice C rationale
Slurred speech is a common symptom of hypoglycemia, indicating that the brain is not receiving enough glucose to function properly.
Choice D rationale
Polyuria is a symptom of hyperglycemia, where excess glucose in the blood leads to increased urine production.
Correct Answer is A
Explanation
Choice A rationale
A temperature of 38°C (100.4°F) and a stiff neck are classic signs of meningitis, indicating inflammation of the meninges.
Choice B rationale
Myocardial infarction typically presents with chest pain, not a stiff neck.
Choice C rationale
Appendicitis presents with abdominal pain, not a stiff neck.
Choice D rationale
Pneumonia presents with respiratory symptoms, not a stiff neck.
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