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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

Answer and Explanation

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.

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Correct Answer is ["A","C","D","E"]

Explanation

A. Ensure NPO status: The client is kept NPO before the biopsy to reduce the risk of aspiration if sedation is used.

B. Administer diphenhydramine (Benadryl) prior to procedure: This is not routine for kidney biopsy unless the client has allergies or specific indications.

C. Obtain coagulation studies: Important to assess for bleeding risk because kidney biopsies have a high bleeding potential.

D. Verify informed consent: This is essential before any invasive procedure.

E. Collect a urine specimen prior to procedure: A pre-procedure urine sample is collected for baseline comparison.

A. Encourage the client to cough and auscultate the lungs again. B. Document the change and continue to monitor the client's respiratory rate. C. Notify the health care provider and prepare for endotracheal intubation. D. Reposition the client in high-Fowler's position and reassess breath sounds.

Correct Answer is C

Explanation

A. Encourage the client to cough and auscultate the lungs again:
This delays necessary intervention and is not appropriate for suspected airway compromise.

B. Document the change and continue to monitor the client's respiratory rate:
Passive monitoring is not safe here given signs of impending respiratory failure.

C. Notify the health care provider and prepare for endotracheal intubation:
Facial burns and decreasing breath sounds suggest airway edema—immediate intubation is critical before complete airway obstruction.

D. Reposition the client in high-Fowler's position and reassess breath sounds:
While positioning helps breathing, it’s not sufficient or timely enough in a rapidly deteriorating airway.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing a client for the operating room Exhibits A nurse is planning care for a client who is scheduled to have a kidney biopsy. Which of the following interventions should the nurse include in the plan? (Select all that apply)

Correct Answer is ["A","C","D","E"]

Explanation

Correct Answer is C

Explanation

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