A client with fluid volume overload is admitted to the hospital for diuresis. Which assessment should the nurse perform to evaluate the client's fluid balance?

Turgor.

Blood pressure.

Weight.

Lung sounds.

Answer and Explanation

The Correct Answer is C

A. Turgor is not a reliable indicator of fluid balance in clients with fluid volume overload, as it is more commonly used to assess dehydration.

B. Blood pressure is affected by fluid volume but is not a direct or specific measure of fluid balance. Other factors, such as medication or underlying conditions, can influence blood pressure.

C. Weight is the most accurate and sensitive indicator of fluid balance. A change in weight directly correlates with fluid retention or loss, making it the preferred method for evaluating fluid balance.

D. Lung sounds can indicate fluid overload if crackles are present, but they are not a quantitative measure of fluid balance and do not provide ongoing assessment of fluid changes.

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Correct Answer is A

Explanation

A. Verify client's identification by scanning the barcode on the armband is correct because verifying the client’s identity is the next step after accessing the eMAR. This ensures that the right medication is given to the right client, following the “rights” of medication administration.

B. Reconcile the medication to be administered with the initial client prescription is important but should already have been completed during the medication preparation and verification process.

C. Remove the medication from the unit dose packaging while verifying the dose is part of the preparation process but occurs after confirming the client’s identity.

D. Scan the medication barcode to document administration on the eMAR is done after verifying the client’s identity and ensuring the medication is correct. It is not the immediate next step after logging into the eMAR.

Correct Answer is ["2.5"]

Explanation

Convert mcg to mg: 1 mg = 1000 mcg, so 125 mcg = 125/1000 = 0.125 mg

· Set up a proportion: (Desired dose / Concentration) = Volume to administer

0.125 mg / 0.05 mg/mL = X mL

· Solve for X: X = 2.5 mL

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A client with fluid volume overload is admitted to the hospital for diuresis. Which assessment should the nurse perform to evaluate the client's fluid balance?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When administering a new medication to a client, the nurse logs in the electronic medication administration record (eMAR). Which action should the nurse take next?

Correct Answer is A

Explanation

The healthcare provider prescribes digoxin elixir 125 mcg PO daily. The drug is available in a 60 mL bottle labeled, "Digoxin elixir 0.05 mg/mL How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Correct Answer is ["2.5"]

Explanation

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