A nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect?

Distended neck veins

Postural hypotension

Dependent edema

Bradycardia

Answer and Explanation

The Correct Answer is B

A.   Extracellular fluid volume deficit (dehydration) typically leads to decreased venous return and reduced preload, resulting in flat or collapsed neck veins, rather than distended ones.
B.   In extracellular fluid volume deficit, there is a decrease in blood volume, which can result in postural hypotension when the client changes positions, due to inadequate fluid volume to maintain blood pressure.
C.   Extracellular fluid volume deficit is characterized by decreased fluid volume, which leads to decreased tissue perfusion and fluid shifts out of the interstitial spaces, resulting in reduced or absent edema.
D.   Bradycardia is not typically associated with extracellular fluid volume deficit.

Instead, tachycardia may occur as a compensatory mechanism to maintain cardiac output in response to decreased blood volume.

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

Explanation

A. Comparing the medication administration record with the medication container should occur before documentation to ensure accuracy.
B. This step ensures that the nurse is administering the correct medication to the client.
C. Comparing the medication against the administration record while removing it from the container helps prevent errors.
D. While important, this step does not directly involve comparing the medication container with the administration record.
E. Verifying the medication at the bedside ensures the right medication is given to the right patient at the right time.

A. The client's pupils constrict in response to light. B. The client's tongue is in a midline position: C. The client has a symmetrical smile. D. The client turns their head against resistance.

Correct Answer is C

Explanation

A. This response is associated with cranial nerve II, the optic nerve.

B. Tongue position is associated with cranial nerve XII, the hypoglossal nerve.

C. A symmetrical smile is indicative of cranial nerve VII, the facial nerve.

D. This action is associated with cranial nerve XI, the accessory nerve.

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A nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer prescribed medications to a client. According to the rights of medication administration, when should the nurse compare the medication administration record against the medication container? (Select all that apply.)

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

Explanation

A nurse is assessing a client's cranial nerve VII. Which of the following responses should the nurse expect?

Correct Answer is C

Explanation

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