A nurse is assessing a client who is receiving intravenous therapy. The nurse should identify which of the following findings as a manifestation of fluid volume excess?
Decreased bowel sounds.
Bilateral muscle weakness.
Thready pulse.
Distended neck veins
The Correct Answer is D
Distended neck veins are a sign of increased central venous pressure, which can result from fluid volume excess. Fluid volume excess can also cause edema, crackles in the lungs, and increased blood pressure.
Choice A is wrong because decreased bowel sounds are not related to fluid volume excess.
Decreased bowel sounds can indicate ileus, obstruction, or peritonitis. Choice B is wrong because bilateral muscle weakness is not a sign of fluid volume excess.
Bilateral muscle weakness can be caused by electrolyte imbalances, neuromuscular disorders, or stroke.
Choice C is wrong because thready pulse is a sign of fluid volume deficit, not excess.
Thready pulse indicates poor perfusion and low cardiac output, which can result from dehydration, hemorrhage, or shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Hyponatremia is a condition where the sodium level in the blood is too low, which can cause confusion, lethargy, seizures, and coma. A hypertonic solution is a fluid that has a higher concentration of solutes than the blood, which can help raise the sodium level and reduce the brain swelling caused by hyponatremia. Therefore, improved cognition indicates that the treatment is effective.
Choice B. Cardiac arrhythmias absent.
Cardiac arrhythmias are not a common symptom of hyponatremia unless it is severe or rapid in onset.
Therefore, their absence does not necessarily indicate that the treatment is effective.
Choice C. Decreased vomiting.
Vomiting can be a cause or a consequence of hyponatremia, depending on the underlying condition.
Decreased vomiting may indicate that the patient is less nauseated, but it does not reflect the sodium level or the brain status.
Choice D. Absent Chvostek’s sign.
Chvostek’s sign is a facial twitching that occurs when tapping on the cheek, which indicates hypocalcemia (low calcium level).
It is not related to hyponatremia or hypertonic solution.
Normal ranges for sodium are 135 to 145 mEq/L and for calcium are 8.5 to 10.5 mg/dL.
Correct Answer is B
Explanation
Colesevelam is a bile acid sequestrant that lowers cholesterol by binding to bile acids in the intestine and preventing their reabsorption into the bloodstream. Some possible explanations for the other choices are:
Choice A. Chlorpromazine is wrong because it is an antipsychotic medication that has no effect on cholesterol levels.
Choice C. Colchicine is wrong because it is an anti-inflammatory drug that is used to treat gout and other inflammatory conditions, not high cholesterol.
Choice D. Cimetidine is wrong because it is a histamine H2 receptor antagonist that reduces stomach acid production and is used to treat ulcers and gastroesophageal reflux disease (GERD), not high cholesterol.
Normal ranges for cholesterol levels vary depending on the type of cholesterol and the risk factors of the individual, but generally, total cholesterol should be less than 200 mg/dL, LDL cholesterol should be less than 100 mg/dL, HDL cholesterol should be more than 40 mg/dL for men and 50 mg/dL for women, and triglycerides should be less than 150 mg/dL.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
