Focus On Delegating Prioritizing Triage Disaster Exam Questions With Complete Solutions Graded A+.

FOCUS ON DELEGATING PRIORITIZING TRIAGE DISASTER EXAM QUESTIONS WITH COMPLETE SOLUTIONS GRADED A+. A home care nurse is assigned to visit a prenatal client with a diagnosis of hyperemesis gravidarum (HEG). During physical assessment of the client, the nurse should first: - ANSWER -Assess the client's intake and output Rationale: HEG is persistent, uncontrolled vomiting that begins before the 20th week of pregnancy. It can have serious consequence, including loss of 5% of prepregnancy weight, dehydration, ketosis, acid-base imbalance, and electrolyte imbalances. Physical assessment begins with determining the client's intake and output, because these data provide information regarding hydration and the nutritional status of the client. The client's weight would be obtained and the baseline value compared with previous and subsequent values. Additionally, the nurse would instruct the client in how to accurately check and monitor her weight. Laboratory data may need to be evaluated; increased hemoglobin and hematocrit values may occur as a result of dehydration. Encouraging the client toverbalize her feelings about the diagnosis is a component of the plan of care but is not the first intervention during physical assessment. A nurse is monitoring a client with preeclampsia who is receiving intravenous magnesium sulfate to prevent seizures.