A nurse is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?
Creatinine 0.8 mg/dL
Hgb 15 g/dL
BUN 18 mg/dL
Sodium 149 mEq/L
The Correct Answer is D
Choice A reason: Creatinine 0.8 mg/dL is within the normal range (0.6-1.2), and it does not indicate fluid volume excess. Creatinine is a waste product of muscle metabolism that is filtered by the kidneys. High creatinine levels can indicate kidney damage or impaired renal function.
Choice B reason: Hgb 15 g/dL is within the normal range (13-17 for men, 12-16 for women), and it does not indicate fluid volume excess. Hgb stands for hemoglobin, which is a protein in red blood cells that carries oxygen to the tissues. Low hemoglobin levels can indicate anemia, bleeding, or hemolysis.
Choice C reason: BUN 18 mg/dL is within the normal range (7-20), and it does not indicate fluid volume excess. BUN stands for blood urea nitrogen, which is a waste product of protein metabolism that is filtered by the kidneys. High BUN levels can indicate dehydration, kidney damage, or high protein intake.
Choice D reason: Sodium 149 mEq/L is high and indicates fluid volume excess. Sodium is an electrolyte that helps maintain fluid balance, blood pressure, and nerve impulses. High sodium levels can cause fluid retention, edema, hypertension, and heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Offering the client frozen banana as a snack is an appropriate intervention for the nurse to take because it can help soothe and cool the inflamed mucous membranes in the mouth and throat, which are caused by stomatitis. Stomatitis is an inflammation of the oral cavity that can result from radiation therapy or chemotherapy. Frozen banana also provides potassium, vitamin C, and fiber for the client.
Choice B reason: Serving the client hot meals is not an appropriate intervention for the nurse to take because it can worsen nausea and vomiting. Hot meals are aromatic, spicy, and greasy, which are characteristics of emetic foods. Hot meals can also irritate the stomach lining and trigger the gag reflex.
Choice C reason: Avoiding serving sauces or gravies is not an appropriate intervention for the nurse to take because it can cause dehydration and malnutrition. Sauces and gravies are liquid, mild, and moist, which are characteristics of antiemetic foods. Sauces and gravies can also enhance the flavor and texture of bland foods and provide calories and nutrients for the client.
Choice D reason: Discouraging the use of a straw is not an appropriate intervention for the nurse to take because it can prevent adequate fluid intake and hydration. Using a straw can help the client sip small amounts of clear liquids, such as water, ginger ale, or broth, which are antiemetic fluids. Using a straw can also reduce the exposure to odors and tastes that may cause nausea.
Correct Answer is C
Explanation
Choice A reason: Eating more tuna is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Tuna should be limited or avoided by clients who have gout.
Choice B reason: Eating more red meat is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Red meat should be limited or avoided by clients who have gout.
Choice C reason: Eating blueberries every morning is an appropriate food choice for a client who has gout because they are low in purines and high in antioxidants, which are substances that protect the cells from damage caused by free radicals. Antioxidants can help reduce inflammation and pain, which are symptoms of gout. Blueberries also provide vitamin C, fiber, and water for the client.
Choice D reason: Eating bananas for a snack is not an appropriate food choice for a client who has gout because they are high in fructose, which is a type of sugar that can increase uric acid levels in the blood. Fructose can worsen gout attacks by triggering inflammation and pain in the joints. Bananas should be limited or avoided by clients who have gout.
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