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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
While calling 911 is important, it is not the first action the nurse should take. The nurse should first assess the victim’s condition.
Choice B rationale:
The first action when someone is choking is to ask if they can speak. If they can speak, it means air is still passing through the windpipe.
Choice C rationale:
The jaw-thrust maneuver is used to open the airway in an unconscious victim, not in a choking victim.
Choice D rationale:
Abdominal thrusts (Heimlich maneuver) are used when the victim cannot speak, indicating a complete airway obstruction.
Correct Answer is C
Explanation
Choice A rationale:
Requesting a prescription for an analgesic for the client is a part of conventional medical treatment.
Choice B rationale:
Checking the client’s oxygen saturation level is a part of conventional medical treatment.
Choice C rationale:
Encouraging the client to take slow, deep breaths can help manage pain and is a holistic nursing approach.
Choice D rationale:
Obtaining blood work from the client is a part of conventional medical treatment.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.