A nurse is caring for a 28-year-old female client who is at 12 weeks of gestation and has been admitted to the emergency department with excessive vomiting for the past 48 hours. The client has lost 2.3 kg (5 lb) over 2 days.
The nurse is assessing the client 24 hours later. How should the nurse interpret the findings 24 hours later? For each finding, click to specify whether the finding is unrelated to the diagnosis, a sign of potential improvement, or a sign of potential worsening.
Urine pH 5.0
Urine specific gravity 1.050
3+ ketones
Urinary output 40 mL/hr
Heart rate 130/min
WBC count 10,000/mmt
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"C"},"D":{"answers":"B"},"E":{"answers":"C"},"F":{"answers":"A"}}
- Urine pH 5.0: This is an improvement as the pH has increased from 4.4, moving closer to the normal range (4.6 to 8).
- Urine specific gravity 1.050: This is a sign of potential worsening as the specific gravity has increased from 1.040, indicating possible dehydration.
- 3+ ketones: This is a sign of potential worsening as the presence of ketones has increased from 2+, indicating the body is breaking down fat for energy due to insufficient glucose.
- Urinary output 40 mL/hr: This is an improvement as the urinary output has increased from 20 mL/hr, indicating better hydration.
- Heart rate 130/min: This is a sign of potential worsening as the heart rate has increased from 128/min, possibly due to dehydration.
- WBC count 10,000/mmt: This is unrelated to the diagnosis as it’s within the normal range (5,000 to 10,000/mm³) and doesn’t directly relate to the client’s symptoms of vomiting and dehydration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Taking charge of all mothering tasks is more indicative of the “taking-hold” phase, which typically occurs a few days after birth.
Choice B rationale
Desiring privacy with the newborn is not specifically indicative of the “taking-in” phase.
Choice C rationale
Putting personal needs aside is not specifically indicative of the “taking-in” phase.
Choice D rationale
Reviewing the birth experience with others is indicative of the “taking-in” phase. During this phase, the new mother is often passive and somewhat dependent, and she may need to review her childbirth experience as a way to fully grasp her new role.
Correct Answer is A
Explanation
Choice A rationale
Uterine tenderness is a common symptom of endometritis, which is an inflammation or irritation of the lining of the uterus.
Choice B rationale
While a high WBC count can be an indicator of infection, a count of 9,000/mm is within the normal range.
Choice C rationale
Scant lochia is not typically associated with endometritis. In fact, women with endometritis may experience heavy lochia or prolonged bleeding.
Choice D rationale
A temperature of 37.4 C (99.3 F) is within the normal range. Endometritis is often associated with fever. .
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.