A nurse is caring for a 68-kg (150-lb) client who has dehydration. Which of the following manifestations is an indication of effective treatment?
Urine specific gravity 1.005 to 1.030
Decreased pulse pressure
Lightheadedness
Urine output 75 mL in 1 hr
The Correct Answer is D
The correct answer is D. Urine output 75 mL in 1 hr.
Adequate urine output (at least 30 mL/hr) indicates effective hydration, showing that the kidneys are functioning properly and fluid balance is improving. A urine output of 75 mL in 1 hour suggests sufficient fluid replacement.
Here’s why the other options are incorrect:
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A. Urine specific gravity 1.005 to 1.030 – This range covers both normal and abnormal values. In dehydration, urine specific gravity is usually high (>1.030) due to concentrated urine. Effective treatment should lead to lower urine specific gravity, but the full range does not confirm improvement.
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B. Decreased pulse pressure – Pulse pressure is the difference between systolic and diastolic blood pressure. Dehydration typically causes a narrowed pulse pressure, so improvement should lead to a normal or increased pulse pressure rather than a decrease.
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C. Lightheadedness – Dizziness and lightheadedness are signs of dehydration-related hypotension. Effective hydration should resolve these symptoms, not maintain them.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Taking too many showers does not increase susceptibility to UTIs by washing o? protective bacteria. This is a misconception.
Choice B reason: Females do have a shorter urethra than males, which makes it easier for bacteria to reach the bladder and cause infections.
Choice C reason: While E. coli is a common bacteria causing UTIs, stating that females have more E. coli is incorrect and not a reason for increased UTIs.
Choice D reason: Sexual activity can increase the risk of UTIs, but it is not appropriate to assume that the client's age correlates with increased sexual activity.
Correct Answer is A
Explanation
The correct answer is Choice A
Choice A rationale: Headache and restlessness can be signs of a seizure or neurological disturbance, which phenytoin is used to treat. Phenytoin is an anticonvulsant medication that helps control seizures by stabilizing neuronal membranes and reducing excitability.
Choice B rationale: Decreased blood pressure and rapid pulse are not indications for phenytoin administration. These symptoms may suggest hypotension or cardiovascular issues, which require different interventions such as fluid resuscitation or vasopressors.
Choice C rationale: Muscle cramps and chest heaviness are not treated with phenytoin. These symptoms could indicate electrolyte imbalances or cardiac issues, which need specific treatments like electrolyte replacement or cardiac monitoring.
Choice D rationale: Pain and tingling at the access site are not indications for phenytoin administration. These symptoms may suggest local irritation or infection at the dialysis access site, requiring appropriate wound care or antibiotics.
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