A nurse is performing an admission assessment on a client. Which finding should the nurse identify as an indication that the client is dehydrated?

Blood pressure 178/90 mm Hg

Edema

Bounding bilateral pulses

Increased urine specific gravity

Answer and Explanation

The Correct Answer is D

A) Blood pressure 178/90 mm Hg: Elevated blood pressure is more commonly associated with fluid overload or hypertension rather than dehydration. In dehydration, one would expect to see a decrease in blood pressure, particularly orthostatic hypotension, due to a reduction in blood volume.

B) Edema: Edema indicates fluid retention in the tissues, which is a sign of fluid overload rather than dehydration. Dehydration typically results in reduced extracellular fluid volume, leading to symptoms like dry mucous membranes and poor skin turgor, rather than swelling.

C) Bounding bilateral pulses: Bounding pulses are usually seen in conditions of increased cardiac output or fluid overload, where there is an excess of fluid volume. In contrast, dehydration often leads to weak and thready pulses due to decreased circulatory volume.

D) Increased urine specific gravity: Increased urine specific gravity is a direct indicator of dehydration. It occurs because the kidneys concentrate urine to conserve water, leading to a higher concentration of solutes in the urine. This is a reliable clinical marker of reduced hydration status, reflecting the body's attempt to maintain fluid balance by conserving water.

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Correct Answer is C

Explanation

A) Cooked carrots: While cooked carrots do contain some potassium, they are not as rich in potassium as other foods. They are a good source of vitamins and nutrients, but not the most effective option for replenishing potassium levels.

B) Cheddar cheese: Cheese generally contains minimal potassium compared to other foods. It is a good source of calcium and protein, but it is not a significant source of potassium. Individuals on loop diuretics like furosemide, which can cause potassium loss, need to consume foods higher in potassium.

C) Baked potato: Baked potatoes are an excellent source of potassium. A medium-sized baked potato with the skin can provide a significant amount of potassium, which is essential for maintaining normal heart function and muscle contraction. This makes it an ideal food choice for clients on diuretics like furosemide, which can deplete potassium levels.

D) 2% milk: While milk contains potassium, it is not as high in potassium as other foods, like fruits and vegetables. Although it can contribute to daily potassium intake, it is not the most potent source for clients needing to increase their potassium levels due to diuretic use.

A. The client's daily calorie intake B. The client's waist circumference C. The client's height D. The client's skinfold thickness

Correct Answer is C

Explanation

A) The client's daily calorie intake: While daily calorie intake is important for understanding a client's nutritional needs and managing their diet, it is not required for calculating BMI. BMI calculation focuses on weight and height rather than caloric intake.

B) The client's waist circumference: Waist circumference is useful for assessing abdominal fat distribution and risk of obesity-related conditions, but it is not needed for calculating BMI. BMI calculation requires height and weight, not waist measurements.

C) The client's height: To calculate BMI, the client's height is essential. BMI is determined by dividing weight in kilograms by the square of height in meters (kg/m²). Accurate height measurement is crucial for this calculation.

D) The client's skinfold thickness: Skinfold thickness measurements are used to estimate body fat percentage but are not required for calculating BMI. BMI relies solely on weight and height, not body fat estimates.

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A nurse is performing an admission assessment on a client. Which finding should the nurse identify as an indication that the client is dehydrated?

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