A nurse is collecting data from a client who has isotonic fluid-volume deficit. Which of the following findings should the nurse expect?

Weak pulse

Distended neck veins

Bradycardia

Pitting Edema

Answer and Explanation

The Correct Answer is A

A. Weak pulse: Isotonic fluid-volume deficit results in decreased blood volume, leading to reduced cardiac output and a weak, thready pulse.

B. Distended neck veins: This is associated with fluid volume excess, not deficit.

C. Bradycardia: Fluid deficit typically leads to tachycardia as the body compensates for decreased circulating volume.

D. Pitting edema: This is a sign of fluid overload rather than deficit.

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Correct Answer is C

Explanation

A. Have the laboratory draw a blood sample for an erythrocyte sedimentation rate (ESR): ESR measures inflammation and is unrelated to hyperkalemia.

B. Restrict fluid intake: Fluid restriction is not appropriate for hyperkalemia unless specifically related to fluid overload or renal failure.

C. Obtain a 12-lead ECG: Hyperkalemia can cause life-threatening cardiac dysrhythmias such as peaked T waves, widened QRS complexes, or asystole. ECG monitoring is essential.

D. Administer potassium gluconate 40 mEq orally: This would worsen hyperkalemia and is contraindicated.

A. "Bradycardia is an early indicator of a pneumothorax." B. "Administer a bronchodilator to the child after chest percussion therapy." C. "Engage the child in daily aerobic exercise." D. "A pigeon-shaped chest might become evident as the disease progresses."

Correct Answer is C

Explanation

. "Bradycardia is an early indicator of a pneumothorax.": Tachycardia, not bradycardia, is an early sign of pneumothorax.

B. "Administer a bronchodilator to the child after chest percussion therapy.": Bronchodilators are typically administered before chest physiotherapy to open airways and enhance mucus clearance.

C. "Engage the child in daily aerobic exercise.": Exercise promotes lung function, airway clearance, and overall physical health in children with cystic fibrosis.

D. "A pigeon-shaped chest might become evident as the disease progresses.": This is incorrect; barrel chest deformities, not pigeon chest, are associated with cystic fibrosis.

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A nurse is collecting data from a client who has isotonic fluid-volume deficit. Which of the following findings should the nurse expect?

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