A nurse is collecting data from an older adult who is postoperative and receiving IV therapy at 125 mL/hr. The nurse should identify that which of the following findings indicates the client is experiencing fluid volume overload? (Select all that apply.).

Crackles in lung bases.

Periorbital edema.

Swelling at the IV site.

Bounding radial pulse.

Flat neck veins when supine.

Answer and Explanation

Correct Answer : A,B,D

Choice A rationale:

Crackles in lung bases Crackles in the lung bases are often indicative of fluid accumulation in the lungs, which can occur in conditions like heart failure. These crackles are discontinuous and sound like "fine rales.”. They can be heard during inspiration and expiration.

Choice B rationale:

Periorbital edema Periorbital edema, or swelling around the eyes, can be a sign of fluid volume overload, especially in the context of an older adult receiving IV therapy. It suggests that excess fluid is accumulating in the body.

Choice D rationale:

Bounding radial pulse A bounding radial pulse is a sign of increased stroke volume and can occur when the heart is working harder to pump the increased blood volume associated with fluid overload.

Choice C rationale:

Swelling at the IV site Swelling at the IV site can be a local reaction and may not necessarily indicate fluid volume overload unless it is associated with other systemic signs.

Choice E rationale:

Flat neck veins when supine Flat neck veins when the client is supine are not typically associated with fluid volume overload. In fact, flat neck veins are more characteristic of hypovolemia. Now, let's address the final question.

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Correct Answer is A

Explanation

Choice A rationale:

The nurse should identify that the client needs liver function tests while taking pyrazinamide. Pyrazinamide is one of the drugs used to treat tuberculosis, and it is known to potentially cause hepatotoxicity (liver damage). Regular monitoring of liver function tests, including liver enzymes like ALT and AST, is essential to detect any liver-related issues early and ensure the client's safety during the medication therapy.

Choice B rationale:

Thyroid function studies are not typically necessary while a client is taking pyrazinamide. Pyrazinamide is not known to have a direct effect on thyroid function.

Choice C rationale:

Blood glucose levels do not need to be monitored specifically due to pyrazinamide therapy. Although some antituberculosis drugs may affect blood sugar levels, pyrazinamide is not a common culprit for such side effects.

Choice D rationale:

Gallbladder studies are not typically indicated while taking pyrazinamide. Pyrazinamide is not known to cause specific issues related to the gallbladder. Monitoring liver function is more critical due to its potential hepatotoxicity.

A. Hypoglycemia. B. Cardiac dysrhythmias. C. Increased appetite. D. Hyperreflexia.

Correct Answer is B

Explanation

Choice A rationale:

Hypoglycemia Hypokalemia (low potassium levels) is not typically associated with hypoglycemia (low blood sugar). Hypokalemia primarily affects the function of muscles and nerves, and it does not directly influence blood glucose levels.

Choice B rationale:

Cardiac dysrhythmias Hypokalemia can lead to cardiac dysrhythmias. Potassium plays a crucial role in maintaining the electrical activity of the heart, and low potassium levels can disrupt normal cardiac rhythms, potentially leading to life-threatening arrhythmias. Cardiac dysrhythmias are a well-recognized complication of severe hypokalemia, making this choice the correct one.

Choice C rationale:

Increased appetite Hypokalemia is not associated with an increased appetite. In fact, it can lead to gastrointestinal disturbances, such as nausea, vomiting, and abdominal pain, which may decrease appetite. The primary manifestations of hypokalemia are related to muscle weakness and cardiac abnormalities.

Choice D rationale:

Hyperreflexia Hyperreflexia (excessive reflex responses) is not a typical manifestation of hypokalemia. Hypokalemia is more commonly associated with muscle weakness, cramps, and cardiac disturbances. Hyperreflexia is often seen in conditions of excessive calcium levels (hypercalcemia) or neurological disorders, not hypokalemia.

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A nurse is collecting data from an older adult who is postoperative and receiving IV therapy at 125 mL/hr. The nurse should identify that which of the following findings indicates the client is experiencing fluid volume overload? (Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has tuberculosis and is about to start taking pyrazinamide.The nurse should identify that the client needs which of the following tests while taking this medication therapy?

Correct Answer is A

Explanation

A nurse is reviewing the laboratory results of a client who is taking a loop diuretic and notes the client's potassium level is 3.0 mEq/L. Which of the following physiological responses should the nurse expect related to the client's hypokalemia?

Correct Answer is B

Explanation

A nurse is collecting data from a client who has hypokalemia as a result of nausea, vomiting, and diarrhea.Which of the following findings should the nurse expect?

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