A nurse is assessing a client who is experiencing hypovolemia. Which of the following manifestations should the nurse expect?

Epistaxis.

Headache.

Dizziness.

Shortness of breath.

Answer and Explanation

The Correct Answer is C

Dizziness is a manifestation of hypovolemia, which is a decrease in blood volume due to fluid loss. Hypovolemia can cause orthostatic hypotension, which is a drop in blood pressure when changing positions. This can lead to dizziness, lightheadedness, or fainting.

Choice A is wrong because it is not a sign of hypovolemia, but rather a possible cause of it. Epistaxis is a nosebleed that can result from trauma, infection, dryness, or coagulation disorders.

Choice B is wrong because it is not a specific sign of hypovolemia, but rather a nonspecific symptom that can have many causes. Headache can be associated with dehydration, but it can also be caused by stress, infection, inflammation, or other factors.

Choice D is wrong because it is not a sign of hypovolemia, but rather a sign of fluid volume excess.

Fluid volume excess is an increase in blood volume due to fluid retention or overload. Fluid volume excess can cause dyspnea, which is difficulty breathing or shortness of breath.

Normal ranges for blood pressure are 90/60 mm Hg to 120/80 mm Hg for adults. Normal ranges for heart rate are 60 to 100 beats per minute for adults.

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

Explanation

The findings that require immediate follow-up are:.

- Adult child accompanying parent reports decline in client, expressing concern over memory and thought process, appetite, and self-care. Adult child states. “My sibling and I hired help at home for my parent. We thought that would help but it has not. I found the title to the car today, signed over to me.”.
- Client makes poor eye contact, speaks in a monotone voice, and has a lack of facial expression. Client reports not wanting to eat anymore. Client’s child reports their parent has lost about 8 lb in the past month.
- Client says. "Why don’t you just leave me? I am of no use.”.

These findings suggest that the client may have cognitive impairment, depression, and/or malnutrition, which can affect their health and quality of life. The nurse should perform a comprehensive assessment of the client’s cognitive, behavioral, and functional status, review their medications and possible side effects, provide education and support for healthy aging, and collaborate with interdisciplinary teams and community resources. The nurse should also evaluate the client’s home environment and lifestyle, and consider nonpharmacological approaches to manage behavioral problems. The nurse should also monitor the client’s vital signs and weight regularly.

A. “A social worker will assist you to find affordable legal representation.” B. “Advance directives can be signed without legal representation.” C. “We can initiate medical care until you get legal assistance in preparing your advance directives.” D. “Advance directives can be a verbal agreement between you and your provider until legal review can be obtained.” E. “Advance directives can be a verbal agreement between you and your provider until legal review can be obtained.”

Correct Answer is B

Explanation

Advance directives are legal documents that allow a person to express their wishes for medical care in case they become incapacitated or unable to communicate. They do not require a lawyer or a notary to be valid, as long as they follow the state laws and are signed by the person and two witnesses.

Choice A is wrong because it implies that legal representation is necessary for advance directives, which is not true.

A social worker can help the client with other resources or support, but not with finding a lawyer for this purpose.

Choice C is wrong because it suggests that advance directives can be verbal, which is not true. Advance directives must be written and signed to be legally binding.

Verbal agreements may not be honored or remembered by the provider or the family.

Choice D is wrong because it implies that advance directives need legal review, which is not true. Advance directives are personal decisions that do not need to be approved by a lawyer or a court.

Legal review may be helpful in some cases, but it is not mandatory or essential.

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System	Findings
General	Adult child accompanying parent reports decline in client, expressing concern over memory and thought process, appetite, and self-care. Adult child states. "My sibling and I hired help at home for my parent. We thought that would help but it has not. I found the title to the car today, signed over to me."
Physical	Client makes poor eye contact, speaks in a monotone voice, and has a lack of facial expression. Client reports sleeping 7 hr a night and getting up "once or twice per night to go to the bathroom." Client reports not wanting to eat anymore. Client's child reports their parent has lost about 8 lb in the past month. Heart rate 68/min
Affect	Client says. "Why don't you just leave me? I am of no use.”

A nurse is assessing a client who is experiencing hypovolemia. Which of the following manifestations should the nurse expect?

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Naxlex Comprehensive Predictor Exams

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

Explanation

A nurse is admitting a client who is hesitant to create advance directives due to concerns about affording legal representation. Which of the following statements should the nurse make?

Correct Answer is B

Explanation

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