The nurse is caring for a patient who has diarrhea. Which nursing action is the highest priority?
a. Provide perineal skin care.
b. Auscultate the abdomen daily.
c. Encourage oral fluid replacement.
d. Provide analgesics for abdominal pain.
ANS: C
Replacing fluids and electrolytes is the first priority which is accomplished by increasing oral fluid intake or using solutions with glucose and electrolytes if ordered by the physician. A. Perineal skin care may or may not need to be done. B. There is no reason to auscultate the abdomen every day. D. There is no indication that the patient is experiencing abdominal pain.
You might also like to view...
A nurse observes the parent–child interaction during the 9-year-old well-child checkup and notes the child is dressed in a seductive adult manner. Which response by the nurse would be most beneficial?
1. Telling the parent, "I am going to refer you to parenting classes, since your child is dressed inappropriately." 2. Asking the child, "Are you happy with the way you are dressed?" 3. Asking the mother to leave the room so she can talk with the child alone 4. Telling the parent, "Let's talk privately. Let's discuss the way your child is dressed, and possible ways to dress more appropriately.
An infant weighs 98 ounces. How many pounds does the infant weigh?
A) 6.125 B) 6.225 C) 6.335 D) 6.456
You are caring for a patient with an indwelling catheter. As the patient returns from the radiology department you note the collection bag is on the side rail. After assuring the patient is comfortably back in his bed you also note the securing device is gone. What should you do?
What will be an ideal response?
When discussing the details of having a procedure done in a facility's ambulatory surgery de-partment, the nurse includes which of the following as advantages? (Select all that apply.)
1. Facilitates faster postsurgical recovery 2. Reduces hospital-oriented expenses 3. Allows for more one-on-one attention by staff 4. Cuts preparation time for surgical procedures 5. Minimizes risk for acquiring a nosocomial infection 6. The anesthetic drugs used result in faster "wake-up" time