For each question, choose your answer, and then give the rationale behind your choice. This will give you the opportunity to earn up to 10 points to be directly applied to exam 2. This must be submitted by the beginning of class 8/2.
Identify the choice that best completes the statement or answers the question.
A 45-year-old client with excess fluid volume because of an acute kidney dysfunction is placed on a 1,000 ml fluid restriction per 24-hour period. The client asks the nurse, “Why is there such a severe fluid restriction when I already have dry lips and mouth?” Which response by the nurse is best? |a. |The doctor ordered the fluid restriction, so it is |c. |You probably drank too much fluid before you got sick, so| | |important to comply with those orders. | |you can’t compare your usual intake to your limitations | | | | |now that your kidneys are not working. | |b. |Your kidneys cannot eliminate extra fluid right now, so |d. |Too much fluid will cause your heart to fail and your | | |intake must be limited to protect your heart and lungs | |lungs to fill with water, which could be fatal | | |from being overloaded with fluid | | |
A 45-year-old female client is receiving a loop diuretic for treatment of edema. The nurse determines the client is experiencing an excessive response to the treatment when the client demonstrates: |a. |BUN 28/mg/dL, hematocrit 45%, and an 8 pound weight loss |c. |BUN 16 mg/dL, Hct 31%, and an 8 pound weight loss in 24 | | |is 24 hours | |hours | |b. |BUN 21 mg.dL, Hct 29%, and an 8 pound weight gain in 24 |d. |BUN 25 mg/dL, Hct 33%, and an 8 pound weight gain in 24 | | |hours | |hours |
A client is receiving an IV infusion of 0.225% sodium chloride at 50 ml/hr. In order to detect complications of therapy, it is most important for the nurse to monitor: |a. |Urine output and concentration |c. |Tongue and mouth for dryness | |b. |Legs and arms for edema |d. |Mental status and orientation |
The nurse is helping a client who was recently places on a low-sodium diet to choose foods for lunch. The nurse recommends which of the following lunch menus as best for this client? |a. |Grilled chicken sandwich on white bread, apple, salad and|c. |Ham and bean soup, fresh fruit salad, pickles, and a soda| | |iced tea | | | |b. |Bologna sandwich on wheat bread, canned fruit cocktail, |d. |Cheeseburger, grapes, fresh pineapple, and tomato juice | | |salad and a soda | | |
A 54-year-old client with liver failure due to cirrhosis comes to the clinic complaining of a swollen abdomen and dizziness upon standing. The client is pale with weak radial pulses, delayed hand vein filling, and distended abdomen. The nurse develops a care plan identifying which of the following nursing diagnoses? |a. |Excess fluid volume:intravascular related to third |c. |Excess fluid volume: extravasular related to hormonal | | |spacing | |disturbances | |b. |Deficient fluid volume: intravascular related to third |d. |Deficient fluid volume: extravascular related to...
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