What is the priority nursing action for a client with severe dehydration?

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Question 1 of 5

What is the priority nursing action for a client with severe dehydration?

Correct Answer: A

Rationale: The correct answer is A: Administer IV fluids. The priority nursing action for a client with severe dehydration is to restore fluid volume to maintain vital organ function. Administering IV fluids is crucial in rapidly replenishing lost fluids and electrolytes. Corticosteroids (choice B) are not indicated for dehydration. Re-administering IV fluids (choice C) is redundant. Administering analgesics (choice D) is not a priority in the management of severe dehydration.

Question 2 of 5

Which of the following foods is most likely to reduce cholesterol?

Correct Answer: A

Rationale: The correct answer is A (Broccoli, oranges, dark greens) because these foods are high in soluble fiber, antioxidants, and plant sterols which are known to help lower cholesterol levels. Broccoli contains fiber that binds to cholesterol in the gut, oranges are rich in vitamin C and fiber, and dark greens like spinach and kale are packed with antioxidants and fiber. Option B (Fiber-rich foods) is partially correct as fiber can help reduce cholesterol levels, but it is not as specific as the foods mentioned in option A. Option C (Increase intake of omega-3 fatty acids) is not directly related to lowering cholesterol, although omega-3s have other health benefits. Option D (Eliminate fat-rich foods) is not ideal as not all fats are bad for cholesterol, and some healthy fats like those found in avocados and nuts can actually improve cholesterol levels.

Question 3 of 5

What is the most effective action when a client with a history of stroke develops difficulty speaking?

Correct Answer: B

Rationale: The correct answer is B: Administer thrombolytics. Thrombolytics help dissolve blood clots, which may be causing the stroke. Administering thrombolytics promptly can improve blood flow to the brain, potentially reducing the severity of the stroke and its effects, including difficulty speaking. Calling for help (A) is important, but administering thrombolytics should be a priority. Performing a CT scan (C) may help confirm the type of stroke but may delay immediate treatment. Administering bronchodilators (D) is not indicated for difficulty speaking related to stroke.

Question 4 of 5

What should the nurse prioritize for a client with suspected sepsis?

Correct Answer: B

Rationale: The correct answer is B: Administer antibiotics. In sepsis, timely administration of antibiotics is crucial to combat the underlying infection. Antibiotics target the bacteria causing the sepsis, helping to prevent further spread and worsening of the condition. Administering IV fluids (choice A) is important to maintain blood pressure, but antibiotics take precedence in treating the infection. Providing fluids (choice C) is also important but not the priority over antibiotics. Administering oxygen (choice D) may be necessary for respiratory support in severe cases of sepsis, but it does not address the root cause of the condition like antibiotics do.

Question 5 of 5

What should the nurse do first when a client presents with symptoms of sepsis?

Correct Answer: A

Rationale: The correct answer is A: Administer IV fluids. The initial priority in managing sepsis is to restore perfusion and oxygenation by giving IV fluids to support blood pressure and organ perfusion. This helps to improve tissue oxygenation and prevents further organ damage. Administering insulin (choice B) is not the priority in the initial management of sepsis. Monitoring blood pressure (choice C) is important but not the first step in the management of sepsis. Administering insulin is also listed twice and is not relevant to the immediate management of sepsis.

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