An older adult is admitted to the hospital. The patient's height is 5 feet, 6 Inches (1.68M), and weigh 250 lb. (113.3kg). The nurse calculates the patient's current body mass index (BMI) as: (Round your answer to the nearest whole number.)

41.0

35.5

30.0

40.0

Answer and Explanation

The Correct Answer is D

To calculate the patient's body mass index (BMI), we need to divide the weight (in kilograms) by the square of the height (in meters). Let's convert the height and weight measurements to the appropriate units and perform the calculation:

Height: 5 feet, 6 inches = 5 + (6/12) = 5.5 feet = 1.6764 meters (rounded to four decimal places) Weight: 250 lb. = 113.3 kg

BMI = Weight (kg) / (Height (m))^2

BMI = 113.3 kg / (1.6764 m)^2

BMI ≈ 40.0

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Correct Answer is C

Explanation

Loop diuretics, such as furosemide, are known to promote diuresis (increased urine output) and can cause electrolyte imbalances, including low potassium (hypokalemia). The patient's statement about eating a diet rich in potassium-containing foods like potatoes, bananas, avocadoes, strawberries, and spinach is incorrect in this context. These foods are indeed good sources of potassium, but when taking loop diuretics, it is necessary to monitor and potentially restrict potassium intake to prevent excessive potassium levels.

"I will weigh myself daily and report to my physician if I gain more than 3 lbs in 1 day." This statement reflects the patient's understanding of the need to monitor their weight daily as a means of assessing fluid balance. Rapid weight gain may indicate fluid retention, which should be reported to the physician.

"This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day." This statement demonstrates awareness of the potential for dehydration when taking loop diuretics and the importance of staying adequately hydrated by consuming an appropriate amount of fluids.

"I will change position slowly because I can become dizzy easily while taking this medication." This statement reflects the understanding that loop diuretics can cause orthostatic hypotension,

leading to dizziness upon sudden changes in position. Taking precautions and changing position slowly can help prevent falls and related injuries.

A. Foot B. Forehead C. Ankle D. Chest E. Sacrum

Correct Answer is E

Explanation

Dependent edema refers to the accumulation of fluid in the dependent parts of the body, which are areas that are most affected by gravity when a person is in a supine or sitting position for an extended period. The sacrum, which is the triangular bone at the base of the spine, is one such dependent area. It is prone to developing edema when there is increased fluid retention in the body, as seen in the patient's weight gain.

To assess for dependent edema accurately, the nurse can gently press the skin over the sacral area with their fingers and observe the skin turgor or the return of the skin to its normal position after releasing the pressure. If there is edema, the skin may have reduced elasticity and take longer to return to its normal position (poor skin turgor).

While edema can occur in other dependent areas such as the feet, ankles, and lower legs, assessing skin turgor in these areas may not provide an accurate determination of dependent edema as they are located further away from the sacrum and may be influenced by other factors.

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An older adult is admitted to the hospital. The patient's height is 5 feet, 6 Inches (1.68M), and weigh 250 lb. (113.3kg). The nurse calculates the patient's current body mass index (BMI) as: (Round your answer to the nearest whole number.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

You're providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points?

Correct Answer is C

Explanation

The patient who is confined to bed in the supine position has gained 5 lbs. in the last 48 hours. In which area does the nurse assess skin turgor for accurate determination of dependent edema?

Correct Answer is E

Explanation

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