You receive report from the oﬀ going nurse that patient L K is admited with hyponatremia. the nurse states he is becoming increasingly confused as the day goes on and management is considering restraining the patient, so he does not become a harm to himself. You assess the patient and note that the IV ﬂuids hanging are 0.33% NaCI. What should you do next?

Bring the patient to the nurse s station so he can be watched until he regains orientation.

Get an order for additional lab work.

Call the doctor and get an order for restraints.

Disconnect the IV ﬂuids immediately they are dropping his Na+ levels.

Answer and Explanation

The Correct Answer is B

Hyponatremia is a condition where the sodium levels in the blood are abnormally low. It can cause confusion, seizures, and even coma in severe cases. The IV ﬂuids hanging are 0.33% NaCI, which means they have a low sodium concentration, and may be contributing to the patient's hyponatremia.

Given that the patient is becoming increasingly confused, it is important to assess his mental status and monitor him closely to prevent harm. However, restraining the patient should not be the first course of action. Instead, the nurse should focus on identifying the underlying cause of the hyponatremia and taking appropriate steps to address it.

Therefore, the next step would be to get an order for additional lab work to assess the patient's electrolyte levels and identify the cause of the hyponatremia. This will help to guide further treatment and management decisions for the patient.

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Correct Answer is ["B","C","E"]

Explanation

Explanation: Central venous catheters are catheters that are inserted through a vein in the chest, neck, or groin and then threaded through to a large vein near the heart. These types of catheters are used for long- term treatment and monitoring of critically ill patients.

A midline catheter is a type of peripheral IV catheter that is longer and extends into the upper arm, but it does not reach a central vein and is not considered a central line. Therefore, option a. is incorrect.

A peripheral IV catheter is inserted into a peripheral vein (e.g., hand, arm), and it does not reach a central vein, making it a peripheral line. Therefore, option d. is incorrect.

A tunneled catheter is a type of central venous catheter that is inserted through a small incision in the chest and then tunneled under the skin to a central vein. It is typically used for long-term treatment and is less likely to become infected than a non-tunneled catheter. Therefore, option b. is correct.

A non-tunneled catheter is a type of central venous catheter that is inserted directly into a central vein in the chest, neck, or groin. It is typically used for short-term treatment and is more likely to become infected than a tunneled catheter. Therefore, option c. is correct.

A PICC line (peripherally inserted central catheter) is a type of central venous catheter that is inserted through a vein in the arm and then threaded through to a central vein near the heart. It is typically used for long-term treatment and is less invasive than other types of central lines. Therefore, option e. is correct.

A. The chest tube drainage system should be placed on the bedside table. B. The chest tube drainage system should be placed on the bed near the patient. C. The chest tube drainage system must be placed below the site of insertion. D. The chest tube drainage system should be placed on the siderail near the patient.

Correct Answer is C

Explanation

: Chest tube placement is done to remove air or ﬂuid from the pleural space, which is the area between the lungs and the chest wall. The chest tube drainage system is an important tool to monitor and manage the drainage from the chest tube.

It is essential that the chest tube drainage system is placed below the level of the patient's chest and the site of insertion. This is necessary to create a continuous drainage system by allowing gravity to assist in the ﬂow of air or ﬂuid out of the pleural space. If the chest tube drainage system is placed above the insertion site, the ﬂuid will not drain properly, which can cause the ﬂuid to back up into the patient's chest cavity, leading to complications such as pneumothorax or hemothorax.

Therefore, the appropriate statement regarding a chest tube is that the chest tube drainage system must be placed below the site of insertion.

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Naxlex Comprehensive Predictor Exams

The nurse is working on a cardiac unit with several patients who have intravenous access lines. The nurse identifies the following are considered central venous catheters: (Select All That Apply)

Correct Answer is ["B","C","E"]

Explanation

The nurse is caring for a client with a chest tube. Which is the following statements is appropriate regarding a chest tube?

Correct Answer is C

Explanation

Your patient is ordered an EKG upon admission to the hospital. She is very scared and states she has never had one of these diagnostic tests before. Which answer is most appropriate by the nurse regarding EKG.

The nurse is caring for a client who requires IV ﬂuids. which IV ﬂuid type would be considered a hypertonic solution?

Your patient has a CMP drawn to determine their electrolytes. Only part of the values have resulted including the Na+ which is 121 mEq/l. What type of electrolyte imbalance is the patient having?

A nurse is assessing the breath sounds of a newborn. Which sound is an expected finding for this developmental level?

The nurse is working in the intensive care unit and has just received lab results for her patients. Which of the following are considered electrolyte imbalances? (Select all That Apply)

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During a Cardiac Stress test, a patient complains of chest pain while running The chest pain subsides when he stops running and is relaxed. The patient is diagnosed with Stable angina and is given education by the nurse. He understands the lack of muscles is causing stable angina during exercise.

MA is a 85 year old female who is admited to the hospital with Pneumonia. Education has begun on proper breathing techniques to expand lung volume as much as possible and allow for proper oxygen blood exchange within the alveoli. Which device will help her achieve this as educated by the nurse?