A nurse is planning care for a client who has pyelonephritis. Which of the following interventions should the nurse include in the plan?
Provide instruction on pelvic muscle exercises.
Administer skeletal muscle relaxants every 6 hr.
Encourage fluid intake.
Monitor vital signs every 8 hr.
The Correct Answer is C
A) Provide instruction on pelvic muscle exercises:
Pelvic muscle exercises are beneficial for urinary incontinence but are not a standard intervention for treating pyelonephritis. Pyelonephritis focuses on managing infection and inflammation of the kidneys rather than strengthening pelvic muscles.
B) Administer skeletal muscle relaxants every 6 hr:
Skeletal muscle relaxants are not typically used in the treatment of pyelonephritis. The focus should be on antibiotics to treat the infection and analgesics for pain relief, rather than muscle relaxants.
C) Encourage fluid intake:
Increasing fluid intake helps flush bacteria from the urinary tract, which can aid in reducing the infection and promoting kidney health. Proper hydration is crucial for clients with pyelonephritis to help manage symptoms and prevent further complications.
D) Monitor vital signs every 8 hr:
While monitoring vital signs is important, it should be done more frequently than every 8 hours, especially in the acute phase of pyelonephritis, to promptly identify any signs of worsening infection or sepsis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) It manifests as a sense of relief upon the loved one's death: This describes a possible outcome of anticipatory grief but does not define anticipatory grief itself. While relief can be a reaction, it is not the core characteristic of anticipatory grief.
B) It causes a prolonged grief response to occur: Anticipatory grief involves experiencing grief before the actual loss occurs. This process can sometimes lead to a prolonged grief response, as individuals might go through stages of grief before and after the loss.
C) It occurs when the loss of a loved one cannot be shared openly: This describes disenfranchised grief, which happens when the loss is not socially acknowledged or supported. Anticipatory grief occurs prior to the loss, not due to a lack of social support.
D) It remains difficult to process due to a lack of finality: While anticipatory grief can be challenging due to ongoing uncertainties and emotional strain, it is not primarily defined by a lack of finality. The grief occurs as individuals anticipate the impending loss.
Correct Answer is D
Explanation
A) Talking with the client's family to determine how the condition affects the client role:
Understanding the client's role within the family is important for comprehensive care, but it is not the most immediate priority in discharge planning. This information can be gathered once the client has the tools to manage their condition effectively.
B) Assessing the impact of the client's body image changes:
While body image is a significant concern for many clients with chronic conditions, it does not directly affect the immediate physical ability to manage daily activities and pain, which is crucial for someone with osteoarthritis.
C) Giving the client printed information about when to use hot and cold therapy:
Providing education on managing symptoms is essential, but simply giving printed information might not address the client's immediate need for practical assistance and adaptations necessary for self-care at home.
D) Consulting occupational therapy to provide assistive devices for self-care:
Ensuring the client has access to assistive devices through occupational therapy is the priority because it directly addresses their ability to perform activities of daily living independently and safely. This intervention can significantly improve the client’s quality of life and reduce the risk of complications.
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