A nurse is caring for a client with suspected viral gastroenteritis. What assessment finding should the nurse prioritize?
Skin turgor and mucous membranes
Blood pressure and heart rate
Urinary output and specific gravity
Respiratory rate and lung sounds
The Correct Answer is A
A) Correct. Skin turgor and mucous membranes are important indicators of hydration status, which is a critical concern in clients with gastroenteritis.
B) Incorrect. While blood pressure and heart rate are important vital signs, they may not provide immediate information about the client's hydration status.
C) Incorrect. Urinary output and specific gravity are important indicators of renal function, but they may not provide immediate information about the client's hydration status.
D) Incorrect. Respiratory rate and lung sounds are important assessments, but they may not provide immediate information about the client's hydration status.
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Related Questions
Correct Answer is B
Explanation
A) Incorrect. Electrolytes are primarily absorbed in the small intestine, not the large intestine.
B) Correct. Gastroenteritis can lead to electrolyte imbalances, especially when there is excessive vomiting and diarrhea, as these processes result in the loss of important electrolytes.
C) Incorrect. Gastroenteritis can lead to electrolyte imbalances, so electrolyte levels may not remain stable in affected individuals.
D) Incorrect. Electrolytes play a crucial role in various physiological processes, and their imbalance is a significant aspect of the pathophysiology of gastroenteritis.
Correct Answer is D
Explanation
A) Incorrect. Limiting hand hygiene is not a recommended practice; in fact, it increases the risk of infection.
B) Incorrect. While vaccinations are important for overall health, there is no specific vaccine for all types of gastroenteritis.
C) Incorrect. Encouraging children to share personal items can increase the risk of spreading gastroenteritis.
D) Correct. Practicing good hand hygiene and proper food handling are essential measures to prevent the spread of gastroenteritis, especially in young children who may be more susceptible to infections.
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