In early-pregnancy class, the nurse emphasizes the importance of 8–10 glasses of fluid per day. How many of these should be water?
1. 1–2
2. 2–4
3. 4–6
4. 3–5
3
Rationale 1: One to two glasses of water is not an adequate intake.
Rationale 2: Two to four glasses of water is not an adequate intake.
Rationale 3: The patient should consume 4–6 glasses of water per day to supply herself and the fetus with adequate fluid.
Rationale 4: Three to five glasses of water is not an adequate intake.
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A nurse is caring for an 85-year-old patient experiencing urinary incontinence. This nurse is aware that:
A) Antispasmodics are often prescribed to decrease urinary incontinence. B) Restricting fluid intake is recommended. C) Reflux incontinence is common in the elderly. D) Urinary incontinence is not a consequence of aging.
The nurse is conducting a physical assessment for a homeless patient. Which action by the nurse is most appropriate?
1) Donning full personal protective equipment (PPE) before touching the patient 2) Asking the patient the last time personal hygiene was performed 3) Gaining permission from the patient before touching 4) Telling the patient to remove clothing and place in a bag
The client is being treated with Epoetin Alfa. The nurse notes that his blood pressure, which had a baseline reading of 114/82, has risen to stay consistently at 142/90 or higher. What is the highest priority action on the part of the nurse?
a. Contact the physician; this is indicative of an adverse reaction to the medication. b. Contact the pharmacist; this is indicative of the drug being prepared in error. c. Contact the pharmacist; this indicates the client is experiencing an anaphylactic reaction. d. Contact the physician; this is an expected side effect of the medication.
A nurse needs to take the BP of a new patient admitted to the unit. The patient has an arteriovenous fistula in her left lower arm and a right sided mastectomy. which is the best site and proper technique to measure blood pressure on this patient.
A. Left upper arm, standard cuff size, auscultate brachial artery. B. Left thigh, appropriate sized cuff, supine patient position C. Left ankle, standard cuff size, auscultate dorsalis pedis. D. right lower arm , appropriate size cuff, auscultate radial artery.