A nurse is collecting data from a client during a routine prenatal visit. The client is in their second trimester of pregnancy and reports feeling dizzy, has a racing heart, and becomes pale while lying on their back.
Which of the following actions should the nurse take?
Provide the client with a glass of orange juice.
Instruct the client to take a brisk walk.
Position the client on their left side.
Check the client's temperature.
The Correct Answer is C
Explanation
C. Position the client on their left side
The symptoms of feeling dizzy, racing heart, and becoming pale while lying on their back are consistent with supine hypotensive syndrome or vena cava syndrome. This condition occurs when the pregnant uterus compresses the vena cava, reducing blood flow back to the heart and causing a drop-in blood pressure.
Positioning the client on their left side helps alleviate the pressure on the vena cava, allowing for improved blood flow and preventing further symptoms. This position optimizes blood circulation and reduces the risk of complications. The nurse should assist the client in turning onto their left side and ensure they are comfortable.
Providing the client with a glass of orange juice (option A) is not recommended as it may be helpful in cases of low blood sugar or hypoglycemia, but it is not the most appropriate action in this scenario.
Instructing the client to take a brisk walk (option B) is not recommended since physical exertion can further worsen the symptoms and increase the risk of complications.
Checking the client's temperature (option D) is not necessary as the reported symptoms are not indicative of a fever or infection.
Therefore, the most appropriate action for the nurse to take in this situation is to position the client on their left side (option C).
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Explanation
A. Administer the medication to the toddler each evening.
Montelukast is a long-term control medication used for the management of asthma in both children and adults. It is typically taken once daily in the evening to provide continuous asthma control. Consistency in taking the medication is important to maintain its effectiveness.
Providing an additional dose of the medication prior to physical activity in (option B) is not a standard recommendation for montelukast use. Montelukast is not a rescue medication and does not provide immediate relief for asthma symptoms triggered by physical activity. In such cases, a short-acting bronchodilator medication, such as albuterol, is commonly used prior to physical activity.
Mixing the medication in juice prior to administration in (option C) is not recommended unless specifically instructed by the healthcare provider or indicated in the medication instructions.
Montelukast is available in various formulations, including chewable tablets and granules, which can be taken directly or mixed with certain foods or liquids. However, the specific instructions should be followed as provided by the healthcare provider or medication label.
Administering the medication when the toddler in (option D) has an acute asthma attack is not the intended use of montelukast. Montelukast is a long-term control medication aimed at preventing asthma symptoms and maintaining asthma control over time. For acute asthma attacks, a short-acting bronchodilator medication is typically used.
Therefore, the nurse should instruct the parents to administer the medication to the toddler each evening (option A) as part of the routine, long-term management of asthma.
Correct Answer is ["A","B","C","D","E","G"]
Explanation
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- Request that the client's family bring the client's eyeglasses from home: This is important to ensure that the client has optimal vision and can see clearly, considering their visual loss. Having their eyeglasses will improve their ability to communicate and understand their surroundings.
- Reorient the client often: Reorientation is important for clients who may be disoriented due to their medical condition or unfamiliar environment. Regularly reminding the client of their location, date, and situation can help them maintain orientation.
- Acknowledge the client's feelings: Acknowledging and validating the client's feelings can help establish rapport and promote a therapeutic relationship. It shows empathy and understanding, which can contribute to the client's overall well-being.
- Provide the client with information about what to expect during their care: Providing information to the client about their care helps promote autonomy and active participation in their own healthcare. It can reduce anxiety and improve the client's overall experience.
- Write the full date on the client's whiteboard: Clearly documenting the full date on the client's whiteboard helps the client stay oriented to the current date and time.
- Maintain a well-lit environment: Ensuring a well-lit environment is important, especially for clients with visual impairment. Sufficient lighting can enhance the client's ability to see and navigate their surroundings.
It's worth noting that while asking the client's partner to stay with the client as much as possible may be beneficial, it may not always be feasible or within the nurse's control. Additionally, requesting the client to have the same caregivers with every shift may not be possible due to staffing constraints.
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