A nurse is caring for a client who is receiving hemodialysis. Which of the following client measurements should the nurse compare before and after dialysis treatment to determine fluid losses?
Neck vein distention
Body weight
Abdominal girth
Blood pressure
The Correct Answer is B
a. Neck vein distention: Neck vein distention may indicate fluid overload, but it is not a direct measure of fluid losses.
b. Body weight: Monitoring body weight before and after hemodialysis provides a direct
measure of fluid losses. Hemodialysis removes excess fluid, and changes in body weight reflect fluid balance.
c. Abdominal girth: Abdominal girth may be affected by fluid accumulation but is not a direct measure of fluid losses during hemodialysis.
d. Blood pressure: While blood pressure may be influenced by fluid status, it is not a specific measure of fluid losses during hemodialysis. Body weight is a more direct indicator of fluid removal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
a. Urine in the drainage appliance: The presence of urine in the drainage appliance is expected in a client with an ileal conduit, as this is the route for urine to exit the body.
b. Feces in the drainage appliance: An ileal conduit is created for urinary diversion, and feces
should not be present in the drainage appliance. This finding could indicate a complication and should be reported.
c. Mild edema of the stoma: Mild edema of the stoma may be expected in the early postoperative period and may not require immediate reporting unless it worsens.
d. Redness of the stoma: Some redness is normal around a stoma, and it may not require immediate reporting unless there are signs of infection or worsening inflammation.
Correct Answer is C
Explanation
a. Magnesium 1.9 mg: This magnesium level is within the expected reference range (1.3-2.1 mEq/L).
b. Chloride 99 mEq/L: This chloride level is within the expected reference range (98-106 mEq/L).
c. Sodium 126 mEq/L: A sodium level of 126 mEq/L is significantly below the normal range (135-145 mEq/L), indicating hyponatremia, which can have serious consequences and requires prompt attention.
d. Potassium 3.6 mEq/L: This potassium level is within the expected reference range (3.5-5.0 mEq/L).
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