Exhibits here
The nurse is implementing the plan of care.
For each body system, click to specify the potential nursing intervention that would be appropriate for the care of the client. Each body system may support more than one potential nursing intervention. Each category must have at least one response option selected.
The Correct Answer is []
Immunological Administer antihistamine
The correct answer is to administer antihistamine. Antihistamines can help alleviate symptoms of an allergic reaction, such as itching, hives, and swelling, by blocking the effects of histamine
released during the allergic response.
Cardiovascular
Monitor vital signs continuously
The correct answer is to monitor vital signs continuously. Continuous monitoring of vital signs, including blood pressure, heart rate, and oxygen saturation, is essential to detect any changes in the client's cardiovascular status, especially after experiencing adverse reactions to medication.
Provide warmth
Providing warmth can help improve peripheral circulation and comfort for the client, especially if they are experiencing symptoms such as dizziness or feeling cold due to a drop in blood pressure.
Respiratory
Assess lung sounds
The correct answer is to assess lung sounds. Assessing lung sounds can help determine if the client is experiencing any respiratory distress or complications, such as wheezing or crackles, which may indicate a need for further intervention or respiratory support.
Chest x-ray
Ordering a chest x-ray can help evaluate the client's respiratory status, especially if there are concerns about potential complications such as pneumonia or pulmonary edema. It allows for the assessment of lung fields and can provide valuable information about the client's respiratory function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Administer with meals and a bedtime snack. This schedule does not ensure that the medication is administered at equally spaced intervals throughout the day, as required for 4 divided doses.
B. 1000, 1600, 2200, 0400. This schedule is not practical or feasible, as it includes a dose in the middle of the night.
C. 0800, 1200, 1600, 2000. This schedule provides equally divided doses at intervals that are practical and coincide with the client's waking hours.
D. Give in equally divided doses during waking hours. While this option mentions administering doses during waking hours, it does not specify specific times for administration, unlike option C.
Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"C"},"F":{"answers":"B"}}
Explanation
1. Poor personal hygiene
- Neglect: X
Rationale: Poor personal hygiene indicates neglect, as the caregiver is not providing adequate care for the client's basic needs.
2. Over sedation
- Physical abuse: X
Rationale: Over sedation is consistent with physical abuse because it involves administering medication to subdue the client, potentially to control or silence them.
3. Bruises in various stages of healing
- Physical abuse: X
Rationale: Bruises in various stages of healing are a sign of physical abuse, indicating that the client has been physically harmed multiple times over a period.
4. Depression or withdrawn behavior
- Mistreatment: X
Rationale: Depression or withdrawn behavior can be a result of mistreatment, which includes emotional and psychological abuse, leading to social isolation and emotional distress.
5. Untreated pressure injuries
- Neglect: X
Rationale: Untreated pressure injuries are a clear sign of neglect, as the caregiver is failing to provide necessary medical care to prevent and treat these injuries.
6. Leaving an older adult in a public space
- Mistreatment:
Rationale: Abandonment, which is a form of mistreatment, involves leaving the older adult in a public space without care or supervision.
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