A nurse is collecting data from a client who is 8 hr postoperative following abdominal surgery. The client's blood pressure is 94/56 mm Hg. Which of the following actions should the nurse take first?
Increase the IV flow rate.
Cover the client with a warm blanket.
Compare the reading to the preoperative value.
Reassure the client.
The Correct Answer is A
A. Increase the IV flow rate: This is correct as the client's blood pressure is low, which could indicate hypovolemia or shock. Increasing the IV flow rate can help improve blood volume and blood pressure.
B. Cover the client with a warm blanket: While this can help with hypothermia, it does not address the immediate concern of low blood pressure.
C. Compare the reading to the preoperative value: Comparing to the preoperative value can provide context but does not directly address the current low blood pressure.
D. Reassure the client: Reassuring the client is important but not the first priority. Addressing the physiological issue of low blood pressure should be the initial focus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "I should use my wrist to test the temperature of the water before bathing": This is correct as using the wrist to test water temperature helps prevent burns or injuries, which is crucial for individuals with diabetes who may have reduced sensation in their feet.
B. "I should put lotion between my toes every day to prevent dryness and cracking": This is incorrect because applying lotion between the toes can promote fungal infections. Lotion should be applied to the tops and soles of the feet, avoiding the spaces between the toes.
C. "I should apply a heating pad to my feet every night to help with circulation": This is incorrect as heating pads can cause burns due to decreased sensation. It is safer to avoid direct heat applications.
D. "I should round the corners of my toenails with a nail file to prevent ingrown nails": This is incorrect; toenails should be trimmed straight across to prevent ingrown nails rather than rounded.
Correct Answer is ["1.5"]
Explanation
• Desired dose: 15,000 units
• Available concentration: 10,000 units/mL
• To find the volume to administer, we can use the formula:
• Volume to administer (mL) = Desired dose (units) / Concentration (units/mL)
• Volume to administer = 15,000 units / 10,000 units/mL = 1.5 mL
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