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 D

Explanation

A. Eating a bland diet and avoiding spicy foods are not specific recommendations for diverticulosis management. They may be applicable for other gastrointestinal conditions.

B. Having small frequent meals and sitting up after meals are general dietary recommendations for digestive health but are not specific to diverticulosis management.

C. Eating a soft diet with increased intake of milk and milk products may not be suitable for diverticulosis management, especially if lactose intolerance is present. Additionally, a soft diet may lack sufficient fiber.

D. Eating a high-fiber diet and increasing fluid intake are key recommendations for managing diverticulosis. High-fiber foods help promote regular bowel movements and prevent constipation, which can exacerbate diverticulosis.

Correct Answer is ["125"]

Explanation

Correct Answer: 125 mL/hr

Rationale:

To calculate the infusion rate in mL/hr, you can use the formula: (Total Volume in mL) / (Time in hours) = Rate in mL/hr. For 1 liter (which is 1000 mL) of lactated Ringers to be infused over 8 hours, the calculation would be 1000 mL / 8 hr = 125 mL/hr.

Therefore, the nurse should program the infusion pump to deliver 125 mL of fluid per hour.

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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

When conducting discharge teaching for a client diagnosed with diverticulosis, which diet instruction should the nurse include?

Correct Answer is D

Explanation

A client receives a prescription for 1 L of lactated Ringers to be infused IV over 8 hours. The IV administration set delivers 15 gtt/mL. How many mL/hr should the nurse program the infusion pump to deliver? (Enter numerical value only.)

Correct Answer is ["125"]

Explanation

The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?

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The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?

A client receives a prescription for 3 liters of lactated Ringer's IV to infuse over 24 hours. How many mL/hr should the nurse program the infusion pump? (Enter numerical value only)

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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.