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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Supplemental oxygen is administered to increase the amount of oxygen in the body and improve tissue oxygenation. The goal of this intervention is to improve the client's condition and reduce symptoms of hypoxia.
Options a, b, and d are all indicative of ongoing hypoxia and are not desirable outcomes. An increase in heart rate and respiratory rate and restlessness can be a sign that the client is still struggling to breathe and not getting enough oxygen.
Option c, pink mucous membranes, is indicative of improved tissue oxygenation. The mucous membranes, such as those in the mouth and nose, should be a healthy pink color when oxygen levels are adequate. Therefore, the nurse should identify pink mucous membranes as an indication that the intervention was effective in improving the client's hypoxia.
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.
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