A client is experiencing symptoms of fluid overload.
Which of the following interventions would the nurse anticipate as appropriate for this client?
Administering a diuretic medication.
Encouraging increased fluid intake.
Providing a high-sodium diet.
Elevating the affected extremities.
The Correct Answer is A
Fluid overload, also called hypervolemia, is a condition in which the body has too much water.
It can cause edema, hypertension, shortness of breath, and cardiovascular problems.
Diuretics are medications that help the body remove excess fluid through urine.
They are commonly used to treat fluid overload caused by heart failure, kidney failure, cirrhosis, and other conditions.
Choice B is wrong because encouraging increased fluid intake would worsen the fluid overload and increase the risk of complications.
Choice C is wrong because providing a high-sodium diet would also worsen the fluid overload and increase the risk of complications.
Sodium is an electrolyte that regulates fluid balance in the body.
Excess sodium intake can cause water retention and increase blood pressure.
Choice D is wrong because elevating the affected extremities is not an appropriate intervention for fluid overload.
Elevating the extremities can help reduce swelling caused by local factors such as injury or inflammation, but it does not address the underlying cause of fluid overload.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Hypercalcemia is a condition in which the calcium level in the blood is above normal.
This can cause various symptoms, such as confusion, constipation, and bradycardia (slow heart rate).
These are the clinical manifestations that the nurse would expect to observe in a client with hypercalcemia.
Choice A is wrong because muscle spasms are not a common symptom of hypercalcemia.
In fact, hypercalcemia can cause muscle weakness and pain.
Choice E is wrong because polyuria (excessive urination) is not a direct symptom of hypercalcemia, but rather a result of kidney problems caused by hypercalcemia.
Hypercalcemia can make the kidneys work harder to filter the excess calcium, leading to dehydration and thirst.
However, this does not necessarily mean that the client will have polyuria.
Normal ranges for calcium levels in the blood are 8.5 to 10.2 mg/dL (milligrams per deciliter) or 2.1 to 2.6 mmol/L (millimoles per liter).
Correct Answer is C
Explanation
This is because intravenous potassium supplementation is indicated for patients with profound hypokalemia (plasma K+ <2.5 mmol/L) or cardiac arrhythmia. The rate of infusion should not exceed 10 mmol/hour to prevent complications such as hyperkalemia, cardiac arrhythmias, and phlebitis.
Choice A is wrong because monitoring urine output every 8 hours is not sufficient to prevent complications from intravenous potassium replacement therapy.
Urine output should be monitored more frequently (at least every 4 hours) to assess renal function and fluid balance.
Choice B is wrong because administering potassium via a bolus injection is dangerous and can cause fatal cardiac arrhythmias.
Potassium should never be given by intravenous push or intramuscular injection.
Choice D is wrong because encouraging the client to eat potassium-rich foods is not appropriate for patients receiving intravenous potassium replacement therapy.
Oral potassium supplementation is preferred for patients with mild to moderate hypokalemia (plasma K+ 2.5-3.5 mmol/L) who can eat and absorb oral potassium.
Potassium-rich foods include potatoes, legumes, juices, seafood, leafy greens, dairy, tomatoes and bananas.
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