Patient Data
Increase IV fluids to 150 mL/hr
Monitor for adverse reaction to antibiotics
Repeat CD4+ T-cell count STAT
Initiate airborne isolation
Administer antiemetic
Correct Answer : A,B,E
A. This intervention is likely to be ordered due to the patient's fever and elevated heart rate, which may suggest dehydration or the need for increased fluid intake to support hemodynamic stability and mitigate the effects of fever and potential dehydration from fever and nausea.
B. Given the diagnosis of Pneumocystis pneumonia, the patient will likely be on or start antibiotics specific to this infection, such as trimethoprim-sulfamethoxazole. Monitoring for adverse reactions is crucial, especially in a newly diagnosed HIV-positive patient who might be starting multiple new medications.
C. While it is important to monitor CD4 counts in HIV-positive patients to guide treatment decisions, repeating the CD4 count immediately might not be prioritized unless there are specific clinical changes that suggest a rapid decline in immune function. Given the recent test results showing a CD4 count of 443 cells/mm^3, immediate retesting might not be clinically justified unless guided by other symptoms or considerations not detailed here.
D. Pneumocystis pneumonia does not require airborne isolation as it is not typically contagious between people under normal circumstances. Instead, it arises as an opportunistic infection in individuals with weakened immune systems. Hence, this order would not be appropriate unless there were other infections suspected that require such precautions.
E. The patient reports severe nausea, which not only is distressing but can also prevent the patient from taking oral medications and maintain necessary nutrition. Administering an antiemetic can help manage this symptom effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The UAP should not make medication decisions; only a nurse or healthcare provider should do this after assessment.
B. The nurse should evaluate the client’s heart rhythm to determine the effectiveness of the amiodarone and to assess for any arrhythmias or side effects of the medication.
C. Checking the regularity of peripheral pulses is important but secondary to assessing the heart rhythm directly.
D. Restarting the IV infusion might be necessary if there are issues with the IV site, but the primary concern is the client's cardiac status.
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.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.