A client who has undergone a nephrolithotomy procedure 24 hours ago now has a fever of 101° F (38.3° C). What is the nurse's priority intervention?
a. Apply a cooling blanket.
b. Strain the client's urine.
c. Notify the health care provider.
d. Document the finding in the client's chart.
C
The elevated temperature indicates a possible infection. Treatment must be initiated as soon as possible to prevent septic complications. The nurse needs to notify the provider so that appropri-ate diagnostic studies and treatment can be started. The temperature is not high enough to war-rant a cooling blanket, and straining the urine will not help find a cause for the fever.
You might also like to view...
The home care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife who has Alzheimer's disease. He states that he hardly has enough energy to cook and clean the house
The couple has no children, and no relatives live within a close distance. Which community agency would be of greatest benefit to this client? a. A recreational club b. An adult education program c. A daycare center for elderly d. Meals on Wheels
The nurse has provided education for a client prescribed ethosuximide (Zarontin). For which information offered by the client should the nurse notify the healthcare provider?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A. "Did I mention that I used to take phenobarbital for my seizures?" B. "I forgot to tell the doctor that I am allergic to penicillin." C. "I take ginkgo to help improve my memory." D. "My husband and I plan to have a baby in a couple of years." E. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."
To prevent injury to a patient when taking his or her temperature using a rectal thermometer,
a. tell the resident not to move while you are out of the room. b. place a pillow behind the resident. c. stay with the resident and hold the thermometer in place. d. place the resident on his or her stomach
Giving handoff information is not within the nursing assistant's scope of practice.
Answer the following statement true (T) or false (F)