Patient Data

Exhibits

The nurse has identified the priority problem for the client and now must determine proper care interventions.
Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Provide client teaching

Apply oxygen via nasal cannula.

Ask the client for a list of current medications.

Place the client in Trendelenburg position.

Notify the healthcare provider of the client's need for intubation.

Administer medications as ordered.

Answer and Explanation

Correct Answer : A,B,C,F

A. Client education is also important, focusing on asthma management, the importance of carrying a non-expired inhaler, and avoiding known triggers.

B. Oxygen therapy via nasal cannula should be considered due to the patient's oxygen saturation of 88% on room air, aiming to maintain SpO2 above 94%.

C. Requesting a list of current medications is essential for reviewing potential drug interactions and ensuring comprehensive care.

D. Trendelenburg position is not indicated for this condition and could exacerbate breathing difficulties.

E. While the patient's condition should be closely monitored, the current information does not suggest an immediate need for intubation; however, the healthcare provider should be notified if the patient's condition worsens.

F. Administering medications as ordered is crucial to address the immediate respiratory distress.

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Correct Answer is ["0.4"]

Explanation

To determine the correct dosage, the nurse needs to perform a calculation using the information provided. The prescription is for 200,000 units of penicillin, and the available vial concentration is 500,000 units per mL.

To find out how many mLs to administer, the nurse would divide the prescribed units by the concentration of units per mL. This is calculated as 200,000 units divided by 500,000 units/mL, which equals 0.4 mL.

A. Have the client sign the surgical and transfusion permits. B. Notify the healthcare provider of the client's medication history. C. Ensure that the potential for bleeding is explained to the client. D. Observe the heparin injections sites for signs of bruising.

Correct Answer is B

Explanation

A. Having the client sign surgical and transfusion permits is important but not the priority in this situation.

B. Notifying the healthcare provider of the client's medication history, including heparin use, is crucial to ensure appropriate perioperative management and to prevent excessive bleeding during surgery.

C. Explaining the potential for bleeding to the client is important for informed consent but is not the priority in this situation.

D. Observing the heparin injection sites for signs of bruising is important but not the priority compared to notifying the healthcare provider about the client's medication history.

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Patient Data Exhibits The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The healthcare provider prescribes penicillin 200,000 units IM for a client with pneumonia. The available vial is labeled, "Penicillin 500,000 units/mL. How many mL should the nurse administer to this client? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

Correct Answer is ["0.4"]

Explanation

Correct Answer is B

Explanation

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Patient Data

Exhibits

The nurse has identified the priority problem for the client and now must determine proper care interventions.
Based on the client history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.