A nurse in a community clinic is collecting data from a patient who reports frequent vomiting and diarrhea for the past 3 days.
Which of the following findings should the nurse expect? (Select all that apply.)

Hypotension

Bradycardia

Pale yellow urine

Poor skin turgor

Flat neck veins

Answer and Explanation

Correct Answer : A,D,E

A.   Hypotension: Frequent vomiting and diarrhea can cause dehydration, which can lead to hypotension.
B.   Bradycardia: Bradycardia is not typically a symptom of dehydration caused by vomiting and diarrhea.
C.   Pale yellow urine: Dehydration can cause urine to become concentrated, resulting in a darker color, not pale yellow.
D.   Poor skin turgor: Dehydration can cause poor skin turgor, which is skin that lacks elasticity.
E.   Flat neck veins: Dehydration can cause flat neck veins when the patient is lying supine.

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Correct Answer is A

Explanation

Choice A rationale

An elevated white blood cell (WBC) count in a urinalysis can indicate an infection or inflammation in the body. A count of 10 is higher than the normal range, which is typically 0 to 5 WBCs per high power field.

Choice B rationale

Occasional casts in the urine are not typically a cause for concern. Casts are tiny tube-shaped particles that can form due to kidney conditions, but occasional casts can be normal.

Choice C rationale

A pH of 5.0 is within the normal range for urine pH, which is typically between 4.6 and 8.0.

Therefore, this result would not typically need to be communicated to the provider.

Choice D rationale

Dark amber color of the urine can be a sign of dehydration, but it can also be influenced by certain foods, medications, and health conditions. It is not typically a result that needs to be communicated to the provider.

A. Auscultate stomach sounds B. Warm the formula to body temperature C. Assist the client to sit in an upright position D. Discard residual gastric contents

Correct Answer is ["A","B","C"]

Explanation

Choice A rationale

Auscultating stomach sounds is an important step before administering a tube feeding. This helps to ensure that the gastrointestinal system is functioning properly and can handle the feeding.

Choice B rationale

Warming the formula to body temperature can help to increase the comfort of the client during the feeding. However, it is not a necessary step and can be skipped if the client does not have a preference.

Choice C rationale

Assisting the client to sit in an upright position is crucial before administering a tube feeding. This position reduces the risk of aspiration, which can occur if the formula enters the lungs.

Choice D rationale

Discarding residual gastric contents is not recommended. Instead, the nurse should check for residual before the feeding, and if the volume is above the predetermined threshold, the feeding should be delayed and the healthcare provider notified.

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A nurse in a community clinic is collecting data from a patient who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is examining the laboratory results for a client who had a urinalysis. Which finding should the nurse communicate to the provider?

Correct Answer is A

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

A nurse is caring for a patient in a long-term care facility who is receiving enteral feedings via an NG tube. Which of the following actions should the nurse complete prior to administering the tube feeding? (Select all that apply)

Correct Answer is ["A","B","C"]

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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A nurse in a community clinic is collecting data from a patient who reports frequent vomiting and diarrhea for the past 3 days.
Which of the following findings should the nurse expect? (Select all that apply.)