A nurse in a critical care unit is assessing an adult client. Which of the following findings by the nurse indicates a fluid volume deficit?
Heart rate 118/min
Central venous pressure 25 mm Hg
Blood pressure 152/90 mm Hg
Temperature 37.2° C (99° F)
The Correct Answer is A
A. A heart rate of 118/min suggests tachycardia, which is a compensatory mechanism in response to fluid volume deficit. The body increases heart rate to maintain cardiac output when fluid volume is low.
B. A central venous pressure of 25 mm Hg may indicate fluid volume overload rather than deficit. It suggests increased venous pressure, possibly due to excess fluid.
C. A blood pressure of 152/90 mm Hg is within the normal range and does not specifically indicate fluid volume deficit.
D. A temperature of 37.2°C (99°F) is within the normal range and does not specifically indicate fluid volume deficit.
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Related Questions
Correct Answer is A
Explanation
A. Vitamin C deficiency, also known as scurvy, can lead to impaired collagen synthesis, which is essential for maintaining the integrity of connective tissues, including the skin. Without an adequate supply of vitamin C, the skin becomes fragile and prone to breakdown, leading to the development of ulcers and wounds.
B. Hypertension is not directly associated with vitamin C deficiency. However, vitamin C deficiency may indirectly contribute to hypertension due to its role in maintaining blood vessel health and endothelial function.
C. Tachycardia is not directly associated with vitamin C deficiency. However, severe vitamin C deficiency (scurvy) can lead to fatigue and weakness, which may result in an increased heart rate as the body tries to compensate for reduced oxygen delivery to tissues.
D. Kidney stones are not typically associated with vitamin C deficiency. However, excessive intake of vitamin C supplements may increase the risk of kidney stone formation in susceptible individuals due to the conversion of vitamin C into oxalate, which can contribute to stone formation.
Correct Answer is A
Explanation
A. Pork and its by-products, such as ham, are prohibited in strict halal dietary guidelines.
B. Lentils are permissible in halal dietary guidelines and can be included in the client's meal.
C. Fish is generally permissible in halal dietary guidelines, so baked fish with rice is an acceptable option.
D. Beef is permissible in halal dietary guidelines, but the gravy should be checked to ensure it does not contain any non-halal ingredients.
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