A nurse is collecting data about the fluid status of four clients.
Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

A client who has NPO status since midnight for an endoscopy.

A client who has heart failure and is receiving diuretic therapy.

A client who has gastroenteritis and is receiving oral fluids.

A client who has end-stage kidney disease who will undergo dialysis.

Answer and Explanation

The Correct Answer is B

The correct answer is choice B.

Choice A rationale:

A client who has NPO (nothing by mouth) status since midnight for an endoscopy could be at risk for fluid volume deficit. NPO status means the client has not been able to consume fluids orally, which could lead to a decrease in fluid intake. However, the risk is relatively low if the NPO status has only been in place since midnight and the client is otherwise healthy.

Choice B rationale:

A client who has heart failure and is receiving diuretic therapy is at a high risk for fluid volume deficit. Diuretics are used in heart failure to remove excess fluid from the body, but they can also lead to fluid volume deficit if not properly managed. This is because diuretics increase urine output, which can lead to a loss of fluid and electrolytes.

Choice C rationale:

A client who has gastroenteritis and is receiving oral fluids is not typically at risk for fluid volume deficit. Gastroenteritis can cause fluid loss through diarrhea and vomiting, but if the client is able to consume and retain oral fluids, they can usually maintain their fluid balance.

Choice D rationale:

A client who has end-stage kidney disease and will undergo dialysis could be at risk for fluid volume deficit, but this risk is typically well-managed during dialysis. Dialysis removes waste and excess fluid from the blood, and fluid intake is carefully monitored and adjusted based on the individual’s needs. Therefore, while there is a potential risk, it is usually well-controlled under the care of healthcare professionals.

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Correct Answer is C

Explanation

Choice A rationale:

Tilt the head and lift the chin is a technique used to open the airway in an unconscious client, not a conscious one with an airway obstruction.

Choice B rationale:

Turning the client to the side is not the first action to take when a client is conscious and has an airway obstruction.

Choice C rationale:

The Heimlich maneuver is the appropriate action to take for a conscious client who has an airway obstruction. It works by creating an artificial cough, intended to force the obstruction out.

Choice D rationale:

A blind finger sweep should never be performed because it can push the obstruction further into the airway.

A. "I will stop consuming alcohol.”. B. "I must stop smoking.”. C. "I am limiting my intake of fast foods.”. D. "I should lower my HDL cholesterol level.”. E. "I need to monitor my weight.”.

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

Explanation

The correct answers are Choice B: "I must stop smoking.", Choice C: "I am limiting my intake of fast foods.", and Choice E: "I need to monitor my weight."

Choice A rationale:

Stopping alcohol consumption can have various health benefits, but moderate alcohol consumption is not a primary risk factor for coronary artery disease. Instead, excessive drinking is more concerning.

Choice B rationale:

Smoking is a significant risk factor for coronary artery disease. Quitting smoking greatly reduces the risk and improves overall cardiovascular health.

Choice C rationale:

Limiting fast food intake is an important dietary change, as fast foods are often high in unhealthy fats, salt, and calories, which can contribute to coronary artery disease.

Choice D rationale:

The statement "I should lower my HDL cholesterol level" is incorrect. HDL cholesterol is considered "good" cholesterol and helps to protect against heart disease. Therefore, lowering HDL cholesterol would not be beneficial.

Choice E rationale:

Monitoring and maintaining a healthy weight is crucial for reducing the risk of coronary artery disease. Excess weight, particularly around the abdomen, is a known risk factor.

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A nurse is collecting data about the fluid status of four clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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

Explanation

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A nurse is collecting data about the fluid status of four clients.
Which of the following clients should the nurse identify as being at risk for fluid volume deficit?