A nurse is assessing a client who reports nausea and vomiting for 2 days. Which of the following indicates fluid volume deficit?

Decreased hematocrit

Decreased specific gravity of urine

Increased skin turgor

Increased pulse rate

Answer and Explanation

The Correct Answer is D

A. Decreased hematocrit may be seen in fluid volume excess, not deficit.

B. Decreased specific gravity of urine is more indicative of dilution rather than fluid volume deficit.
C. Increased skin turgor is a clinical manifestation of fluid volume deficit.

D. Increased pulse rate is a compensatory response to fluid volume deficit, reflecting the body's attempt to maintain perfusion in the setting of reduced blood volume.

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Correct Answer is A

Explanation

A. Supporting the client in her personal decision respects her autonomy and right to make decisions about her own healthcare.
B. Referring the client to a counselor can be appropriate, but the primary response should be to support the client's decision.
C. Encouraging the client not to give up may not be appropriate if the client has made a well- considered decision to refuse further treatment.
D. Suggesting that the client talk with a breast cancer survivor may provide emotional support but should not be used as a means to persuade the client to undergo further treatment if she has made an informed decision to refuse.

A. Open the first flap of the sterile kit toward himself. B. Ensure that the sterile field is located below waist level. C. Place dry, sterile supplies 1/2 inch from the edge of the sterile field. D. Apply sterile gloves after preparing the sterile field.

Correct Answer is C

Explanation

A. Opening the first flap of the sterile kit away from the body helps maintain the sterility of the contents.
B. The sterile field should be above waist level to avoid contamination.

C. Placing dry, sterile supplies 1/2 inch from the edge of the sterile field helps prevent contamination of the items.
D. Sterile gloves should be donned before preparing the sterile field to avoid contamination.

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A nurse is assessing a client who reports nausea and vomiting for 2 days. Which of the following indicates fluid volume deficit?

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