A nurse is assessing a client who has fluid overload.
Which of the following findings should the nurse expect? (Select all that apply.).
Increased heart rate.
Increased respiratory rate.
Increased temperature.
Increased hematocrit.
Increased blood pressure.
Correct Answer : A,B,E
Choice A rationale:
Increased heart rate is a compensatory mechanism to maintain cardiac output in the presence of fluid overload.
Choice B rationale:
Increased respiratory rate may occur due to pulmonary congestion caused by fluid overload.
Choice C rationale:
Increased temperature is not typically associated with fluid overload.
Choice D rationale:
Increased hematocrit would indicate dehydration, not fluid overload.
Choice E rationale:
Increased blood pressure can occur due to increased blood volume in fluid overload.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Dextrose 10% in water can be used as a temporary replacement for TPN to prevent hypoglycemia until the TPN solution is available.
Choice B rationale:
3% sodium chloride is a hypertonic solution and is not typically used as a replacement for TPN.
Choice C rationale:
0.9% sodium chloride, or normal saline, does not provide the necessary nutrients that are included in TPN.
Choice D rationale:
Lactated Ringer’s is used for fluid resuscitation and does not provide the necessary nutrients that are included in TPN.
Correct Answer is A
Explanation
Choice A rationale:
Sublingual administration of nitroglycerin provides the most rapid onset. This route allows the medication to be absorbed directly into the bloodstream through the mucous membranes under the tongue, bypassing the digestive system.
Choice B rationale:
Sustained-release nitroglycerin is designed to be released slowly over time. This form of the drug does not provide rapid relief of acute angina symptoms.
Choice C rationale:
Transdermal patches of nitroglycerin provide a slow, continuous dose of medication. This is beneficial for long-term management of angina, but it does not provide rapid relief.
Choice D rationale:
Topical ointments also provide a slow, continuous dose of medication and are not intended for rapid relief of acute symptoms.
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