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Patient Data

Exhibits
The healthcare provider has obtained the arterial blood gas and chest X-ray results. New prescriptions have been entered in the client's electronic health record.
Nursing Action: Indicated/ Contraindicated

A.

IV 0.9% normal saline continuous infusion at 100

B.

Daily weights

C.

Calculation of intake and output

D.

IV potassium sparing diuretic

E.

Continuous pulse oximetry monitoring

F.

Electrocardiogram monitoring

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}

A.    Given the client's chronic kidney disease and the risk of fluid overload, a high rate of normal saline infusion may not be appropriate without careful assessment and specific indication from the healthcare provider.
B.    Monitoring daily weight is essential in managing fluid balance and assessing for potential fluid overload, especially in a child with chronic kidney disease.
 
C.    Accurate measurement of intake and output is crucial in managing fluid balance and monitoring kidney function, particularly in a patient with a history of acute kidney injury and chronic kidney disease.
D.    The client already has an elevated potassium level, and administering a potassium-sparing diuretic could worsen hyperkalemia, leading to dangerous cardiac complications.
E.    Continuous monitoring of oxygen saturation is important due to the presence of bibasilar infiltrates on the chest X-ray, which could indicate a potential respiratory issue.
F.    ECG monitoring is indicated due to the elevated potassium level (5.3 mEq/L), which can cause cardiac arrhythmias. The irregular heart rate further supports the need for ECG monitoring.
 


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Related Questions

Correct Answer is C

Explanation

A. Progressing the diet is important but does not address immobility-related complications.
B. Maintaining the IV infusion rate is necessary but not specific to preventing complications from immobility.
C. Applying intermittent pneumatic compression devices helps prevent deep vein thrombosis (DVT), a significant risk for immobile clients post-surgery. This is a critical preventative measure for immobility-related complications.
D. Frequent pain assessments are important but do not specifically prevent complications from immobility.

Correct Answer is {"dropdown-group-1":"A"}

Explanation

Epidural anesthesia, commonly used for pain relief during labor, works by blocking nerve impulses in the lower part of the spine, leading to a decrease in sensation and pain in that area. However, this blockade also affects the sympathetic nerves, which are responsible for regulating blood pressure. When these nerves are blocked, they can cause peripheral vasodilation, which is the widening of the blood vessels in the periphery of the body.

Peripheral vasodilation leads to a decrease in vascular resistance, which can significantly lower blood pressure. This drop in blood pressure, known as hypotension, is a common side effect of epidural anesthesia. Hypotension can reduce the blood flow to vital organs, including the placenta, which may affect fetal oxygenation if not promptly and effectively managed. This necessitates careful monitoring and management, typically involving fluid administration and sometimes the use of medications to maintain stable blood pressure during the administration of epidural anesthesia.

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