A nurse is planning care for a client who has dehydration and hypotension. Which of the following actions should the nurse plan to take?
Instruct the client to perform the Valsalva manoeuvre.
Elevate the head of the client’s bed.
Encourage the client to use guided imagery to relax.
Increase the client’s fluid intake.
The Correct Answer is D
Dehydration can cause hypotension, so increasing fluid intake can help to restore fluid levels and improve blood pressure1. Mild dehydration can be treated with fluids and electrolytes, while moderate-to-severe dehydration may require treatment with intravenous fluids and electrolytes2.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The nurse should expect to find an increased heart rate in a client with a fever. An elevated body temperature can cause an increase in metabolic rate, which can lead to an increase in heart rate. This is a normal physiological response to fever and helps the body to generate heat and fight off infection.
Correct Answer is B
Explanation
Answer: B. A client who is unconscious.
A. A client who has a spinal cord injury.
While a spinal cord injury is serious and requires close monitoring, this condition does not immediately indicate that the client is unstable or at risk for life-threatening complications compared to an unconscious client. However, if there were signs of respiratory compromise or neurogenic shock, this client could be prioritized higher.
B. A client who is unconscious.
An unconscious client should be seen first because their condition may indicate a critical issue such as impaired airway, breathing, or circulation (ABC). Immediate assessment is needed to ensure the airway is clear, breathing is adequate, and circulation is stable, as these are life-threatening concerns.
C. A client who has peripheral vascular disease.
Clients with peripheral vascular disease (PVD) typically have chronic issues related to circulation in the limbs, which can cause pain and discomfort but are not usually immediately life-threatening. While important, this client is not the top priority compared to an unconscious client.
D. A client who has a new ankle sprain.
A new ankle sprain is painful and requires treatment, but it is not life-threatening. The nurse should address this client after ensuring the more urgent needs of other clients are met, such as the unconscious client who may require immediate interventions to preserve life.
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