A nurse is assessing a client diagnosed with chronic renal disease for fluid volume excess. The nurse should recognize that which of the following provides a reliable measure of fluid retention?
Sodium level
Tissue edema
Urinary output
Daily weight
The Correct Answer is D
A. Sodium level: Serum sodium levels can vary and are not a direct measure of fluid retention.
B. Tissue edema: Edema is subjective and can be influenced by other conditions.
C. Urinary output: Many CKD patients have limited or no urine output despite fluid retention.
D. Daily weight: Daily weights are the most reliable non-invasive measure for fluid status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Increased appetite: Not typical in AKI; anorexia is more common.
B. Elevated serum creatinine levels: A hallmark of AKI, indicating reduced kidney filtration capacity.
C. Hyperglycemia: Not a direct indicator of AKI, though may occur in diabetics.
D. Increased urine output: AKI is typically oliguric (low urine output) or anuric in early phases.
Correct Answer is A
Explanation
A. Skin is red, blanches, and weeps: This is consistent with deep partial-thickness burns. These burns damage deeper layers but still allow capillary refill and exudate.
B. Skin has a leathery and dry: This is characteristic of full-thickness (third-degree) burns.
C. Skin is waxy in appearance: A waxy appearance suggests full-thickness burns.
D. Skin is intact, dry, and red in color: This indicates superficial (first-degree) burns like sunburn.
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