A nurse is caring for an adult client who has a fever of 39.4°C (103°F) and is receiving 0.9% sodium chloride IV at 125 mL/hr. Over the last hour, the nurse notes that the client's urine output is 20 mL. The nurse should report this finding to the provider and anticipate a prescription for what?
An antipyretic medication
A diuretic medication
A blood culture
A fluid bolus
The Correct Answer is D
Choice A reason: An antipyretic medication is not the best answer because it does not address the client's low urine output. An antipyretic medication is a drug that lowers the body temperature by reducing the production of heat or increasing the loss of heat. It may help the client feel more comfortable, but it does not improve the kidney function or prevent dehydration.
Choice B reason: A diuretic medication is not the best answer because it may worsen the client's low urine output. A diuretic medication is a drug that increases the excretion of water and electrolytes by the kidneys. It may lower the blood pressure and reduce the fluid overload, but it may also cause dehydration, electrolyte imbalance, and kidney damage.
Choice C reason: A blood culture is not the best answer because it does not address the client's low urine output. A blood culture is a laboratory test that detects the presence of bacteria or other microorganisms in the blood. It may help identify the cause of the fever and guide the antibiotic therapy, but it does not improve the kidney function or prevent dehydration.
Choice D reason: A fluid bolus is the best answer because it may improve the client's low urine output. A fluid bolus is a rapid infusion of a large volume of fluid, usually isotonic saline or lactated Ringer's solution. It may increase the blood volume and pressure, improve the tissue perfusion, and stimulate the urine production. It may also help lower the fever by diluting the pyrogens and increasing the heat loss.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Drinking a minimum of 12 ounces of fluid with each meal is not recommended for a client who has dumping syndrome. Fluids can increase the gastric volume and accelerate the gastric emptying, leading to more severe symptoms. The nurse should advise the client to drink fluids between meals, not with meals.
Choice B reason: Choosing foods that are high in simple carbohydrates is not recommended for a client who has dumping syndrome. Simple carbohydrates can cause a rapid rise and fall of blood glucose levels, resulting in hypoglycemia and weakness. The nurse should advise the client to choose foods that are high in protein and fat, and low in sugar.
Choice C reason: Staying upright when eating and for 30 minutes afterward is not recommended for a client who has dumping syndrome. This position can facilitate the gastric emptying and worsen the symptoms. The nurse should advise the client to lie down after eating to slow down the gastric emptying.
Choice D reason: Eating several small meals daily spaced at equal intervals is recommended for a client who has dumping syndrome. This can help reduce the gastric volume and pressure, and prevent the rapid delivery of food into the small intestine. The nurse should advise the client to eat four to six small meals per day, and avoid skipping meals.
Correct Answer is A
Explanation
Choice A reason: This is the correct answer because weighing 28% above ideal body weight is a sign of obesity. Ideal body weight is an estimate of the weight that corresponds to the lowest mortality for a given height and gender. Obesity is defined as having a body weight that is 20% or more above ideal body weight.
Choice B reason: This is not the correct answer because having a waist circumference of 81.3 cm (32 in) is not a manifestation of obesity. Waist circumference is a measure of abdominal fat, which is associated with increased health risks. However, the cut-off point for waist circumference varies by gender and ethnicity. For women, a waist circumference of more than 88 cm (35 in) is considered high.
Choice C reason: This is not the correct answer because having a BMI of 28 is not a manifestation of obesity. BMI is a measure of body mass index, which is calculated by dividing weight in kilograms by height in meters squared. BMI is used to classify weight status and health risks. For adults, a BMI of 18.5 to 24.9 is considered normal, 25 to 29.9 is considered overweight, and 30 or more is considered obese.
Choice D reason: This is not the correct answer because having a body fat of 22% is not a manifestation of obesity. Body fat is a measure of the percentage of fat in the body, which is determined by various methods such as skinfold thickness, bioelectrical impedance, or underwater weighing. Body fat is influenced by age, gender, and physical activity. For women, a body fat of 21 to 33% is considered normal, 33 to 39% is considered high, and more than 39% is considered very high.
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