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 A
Explanation
Trousseau’s sign is a test for hypocalcemia that involves inflating a blood pressure cuff on the arm and observing for carpal spasm. A positive sign indicates low calcium levels in the blood, which can cause neuromuscular irritability.
Choice B is wrong because hyperactive deep tendon reflexes are a sign of hypomagnesemia, which is a low level of magnesium in the blood.
Choice C is wrong because hyperactive bowel sounds are a sign of hyperkalemia, which is a high level of potassium in the blood.
Choice D is wrong because muscle twitching can be caused by many factors, such as anxiety, caffeine, or electrolyte imbalance, and is not specific to hypocalcemia.
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).
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