A 187-pound patient presents to the emergency department after a motor vehicle accident
The patient is confused, has a superficial cut on the head, a bruised abdomen, and a compound fracture of the right femur. The patient's vital signs are: P–122/minute, R–32/minute, BP–100/51, and T–99.0° F. Based on these findings, the nurse should prepare to administer which of the following intravenous solutions?
a. 0.9% NaCl
b. D5W
c. 3% NaCl
d. D5 NS
ANS: A
Administration of an isotonic solution would be the correct action because of the expected loss in blood volume after the patient's accident and subsequent injuries.
D5W would be indicated for hypoglycemia.
3% NaCl would be indicated for hyponatremia.
D5 NS would also be indicated if the patient had hypernatremia.
You might also like to view...
The nurse is performing a physical exam on a 9-year-old boy who complains of a stiff neck and pain in his arms and legs. He has never been vaccinated for polio. Which of the following assessment findings would suggest the child has polio?
A) Swelling in the neck B) Confusion and anxiety C) Positive Kernig's sign D) Conjunctivitis
When discussing family planning methods, the nurse should plan to
a. choose the method, based on health assessment, that would best suit the client's health risks and needs b. help clients to have a thorough understanding of the method they choose c. include only the female in the discussion d. point out all methods that have the greatest effectiveness
A client has been admitted as a result of lack of food and nutrients in the body. When caring for the client, the nurse finds that the client feels nauseated at meal times. Which is the most appropriate intervention for the nurse?
A) Weighing the client daily B) Providing tube feeding as ordered C) Administering insulin as ordered D) Providing warm milk regularly
An instructor is describing the steps of the diagnostic reasoning process to a group of students. The instructor is accurate when describing step Two, Clustering Data as involving which of the following?:
A) Hypothesizing of any potentially applicable wellness diagnoses, risk diagnoses, and actual diagnoses B) Documentation of all professional judgments along with any data that support those judgments C) The looking at of the identified abnormal findings and strengths for cues that are related D) Evaluation of both subjective and objective data to identify strengths and abnormal findings