how should a nurse manage a patient with fluid overload
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Nursing Elites

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1. How should a healthcare professional manage a patient with fluid overload?

Correct answer: A

Rationale: Corrected Question: When managing a patient with fluid overload, the appropriate approach involves restricting fluids and administering diuretics. This strategy helps remove excess fluid from the body and prevent complications associated with fluid overload. Choice B suggesting increasing fluid intake is incorrect as it would worsen the condition. Choice C, administering antibiotics, is unrelated to managing fluid overload. Choice D, monitoring weight and providing a low-sodium diet, is helpful but not as effective as fluid restriction and diuretics in managing fluid overload.

2. When collecting data from a client with posttraumatic stress disorder (PTSD), which of the following manifestations should the nurse expect?

Correct answer: B

Rationale: The correct manifestation to expect when collecting data from a client with PTSD is hypervigilance. Hypervigilance refers to increased alertness, which is a common symptom of PTSD. This heightened state of awareness is characterized by an exaggerated startle response, being easily startled, and constantly scanning the environment for potential threats. Amnesia (choice A) is not typically a primary manifestation of PTSD; it is more commonly associated with dissociative disorders. Hallucinations (choice C) involve perceiving things that are not present and are not typically a hallmark symptom of PTSD. Severe agitation (choice D) may occur in individuals with PTSD, but hypervigilance is a more specific and common manifestation associated with this disorder.

3. What is the most important intervention for a patient experiencing respiratory distress?

Correct answer: A

Rationale: Administering oxygen is crucial in managing a patient experiencing respiratory distress. Oxygen therapy helps to improve oxygen levels in the blood, supporting vital organ functions. While monitoring airway patency is important, administering oxygen takes precedence in ensuring the patient receives an adequate oxygen supply. Providing bronchodilators may be beneficial in certain respiratory conditions, but the immediate priority in distress is to address oxygenation. Calling for assistance is essential, but the immediate intervention to support the patient's respiratory function is administering oxygen.

4. A nurse is teaching a client who has peptic ulcer disease about preventing exacerbations. Which of the following instructions should the nurse include?

Correct answer: B

Rationale: The correct answer is B: Limit alcohol consumption. Alcohol consumption can aggravate peptic ulcer disease by increasing gastric acid secretion, potentially leading to exacerbations. Choices A, C, and D are incorrect. Choice A is not recommended because antacids containing magnesium can interfere with other medications or conditions the client may have. Choice C is a good recommendation; however, it is not the priority instruction for preventing exacerbations. Choice D is also incorrect as caffeine can stimulate gastric acid secretion, which can worsen peptic ulcer disease.

5. What is the first step when administering a blood transfusion?

Correct answer: B

Rationale: The correct answer is to verify the client's blood type before administration. This step is crucial to ensure compatibility and prevent adverse reactions such as hemolytic transfusion reactions. Warming the blood to body temperature (Choice A) is not the first step and is not typically done during blood transfusions. Administering the blood through an IV push (Choice C) is incorrect as blood transfusions are usually administered as a slow infusion. Administering diuretics before the transfusion (Choice D) is unnecessary and not a standard practice when initiating a blood transfusion.

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