A nurse is monitoring a client who has dehydration and is receiving IV fluid replacement.
Which of the following findings should the nurse identify as effectiveness of the treatment?

Urine output 200 mL/4 hr.

Heart rate 104/min.

Peripheral pulses +1.

Urine specific gravity 1.04. .

Answer and Explanation

The Correct Answer is A

Choice A rationale:

The nurse should identify that an effective outcome of IV fluid replacement in a client with dehydration is an increase in urine output. Urine output of 200 mL in 4 hours indicates that the kidneys are responding to the IV fluid replacement, and the client is likely rehydrating. This suggests that the renal perfusion has improved, and the client's body is eliminating waste products properly.

Choice B rationale:

A heart rate of 104 beats per minute is not necessarily indicative of the effectiveness of IV fluid replacement. Heart rate may vary for various reasons, and it is not a specific parameter for assessing the response to hydration. Other factors, such as blood pressure, should be considered to evaluate cardiovascular status.

Choice C rationale:

Peripheral pulses of +1 are not a direct indicator of the effectiveness of IV fluid replacement. While improved hydration may lead to better peripheral perfusion, this assessment is somewhat subjective and may not accurately reflect the overall effectiveness of the treatment.

Choice D rationale:

A urine specific gravity of 1.04 is not indicative of the effectiveness of IV fluid replacement. A specific gravity of 1.004 is within the normal range (normal range: 1.005-1.030) and does not necessarily indicate hydration status. It is essential to focus on urine output and other objective parameters to assess the effectiveness of hydration therapy. .

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Correct Answer is A

Explanation

Choice A rationale:

Restricting visitation is an essential intervention during an influenza outbreak in a long-term care facility. Influenza is highly contagious and can spread rapidly among residents and staff in a close environment like a long-term care facility. By limiting visitation, the facility can reduce the risk of introducing the virus from the outside and help contain the outbreak. This is a preventive measure to protect vulnerable residents from exposure to the virus.

Choice B rationale:

Providing prophylactic antibiotics for clients who have been exposed to influenza is not a recommended intervention. Influenza is caused by a virus, not bacteria, so antibiotics are ineffective in preventing or treating the infection. Antibiotics should only be used to treat bacterial infections, not viral ones. Inappropriate use of antibiotics can lead to antibiotic resistance and other adverse effects.

Choice C rationale:

Implementing airborne precautions for clients who have influenza is not typically necessary. Influenza primarily spreads through respiratory droplets when an infected person coughs or sneezes. Standard precautions, such as proper hand hygiene and wearing masks when in close contact with infected individuals, are usually sufficient to prevent the spread of the virus. Airborne precautions are typically reserved for diseases that are transmitted through the airborne route, like tuberculosis.

Choice D rationale:

Assigning healthcare personnel to nondirect care activities for 24 hours after developing influenza symptoms is not a recommended intervention. While it's important for healthcare personnel to stay home when they are sick to prevent the spread of the virus, 24 hours may not be a necessary duration. The standard guideline for healthcare workers with influenza is to stay home until they are fever-free for at least 24 hours without the use of fever-reducing medications.

A. The medication will reduce inflammation. B. The medication will open the airways. C. The medication will prevent wheezing. D. The medication will increase the amount of mucus. E. The medication will decrease coughing episodes.

Correct Answer is ["B","C","E"]

Explanation

Choice A rationale:

Albuterol primarily acts as a bronchodilator by opening up the airways. It does not have a significant anti-inflammatory effect. Inhaled corticosteroids are more commonly used to reduce airway inflammation in asthma.

Choice B rationale:

Albuterol, a beta-2 agonist, helps with breathing by relaxing the smooth muscles in the airways, which opens them up. This action allows for improved airflow and ease of breathing. Therefore, this choice is correct.

Choice C rationale:

Albuterol is used to relieve bronchospasm, which can prevent wheezing in individuals with asthma. It does not have a direct effect on reducing mucus production or coughing.

Choice D rationale:

Albuterol does not increase the amount of mucus production. In fact, it can help reduce coughing by relieving bronchospasm, but it does not directly suppress coughing episodes.

Choice E rationale:

Albuterol can help reduce coughing episodes by improving airflow and reducing the irritation that leads to coughing.

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A nurse is monitoring a client who has dehydration and is receiving IV fluid replacement.Which of the following findings should the nurse identify as effectiveness of the treatment?

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Naxlex Comprehensive Predictor Exams

A nurse is assisting with planning interventions for an influenza outbreak in a long-term care facility.Which of the following interventions should the nurse include in the plan?

Correct Answer is A

Explanation

A nurse is caring for a client who has asthma. The client asks the nurse how albuterol helps his breathing. Which of the following information should the nurse include in the response? (Select all that apply.).

Correct Answer is ["B","C","E"]

Explanation

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A nurse is monitoring a client who has dehydration and is receiving IV fluid replacement.
Which of the following findings should the nurse identify as effectiveness of the treatment?