The nurse is caring for an older adult client who is receiving intravenous fluids at 150 mL/hr. Upon assessment, the nurse notes crackles, shortness of breath, and jugular vein distention. Based on this data, which complication of IV fluid therapy does the nurse anticipate?
Fluid volume deficit
Fluid volume excess
Speed shock
Pulmonary embolism
The Correct Answer is B
Choice A reason: Fluid volume deficit is a condition in which the body loses more fluid than it gains, resulting in dehydration, hypotension, and electrolyte imbalances. It is not a complication of IV fluid therapy, but rather a reason for initiating it.
Choice B reason: Fluid volume excess is a condition in which the body retains more fluid than it needs, resulting in edema, hypertension, and heart failure. It is a potential complication of IV fluid therapy, especially in older adults who have reduced renal function and cardiac output. The nurse's assessment findings of crackles, shortness of breath, and jugular vein distention are indicative of fluid overload and pulmonary congestion.
Choice C reason: Speed shock is a systemic reaction that occurs when a substance is administered too rapidly into the bloodstream, causing adverse effects such as chest pain, dyspnea, hypotension, and cardiac arrest. It is not a complication of IV fluid therapy, but rather a risk associated with IV medication administration.
Choice D reason: Pulmonary embolism is a blockage of one or more pulmonary arteries by a blood clot, fat, or air, causing impaired gas exchange, chest pain, dyspnea, and hemoptysis. It is not a complication of IV fluid therapy, but rather a possible outcome of venous thromboembolism, which can be prevented by using anticoagulants and mechanical devices.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This is not the correct answer because this statement by the client indicates that the client understands the dietary restrictions and guidelines that are necessary after bariatric surgery. A liquid/pureed diet and limited fluid intake are recommended to prevent complications such as nausea, vomiting, dehydration, and dumping syndrome.
Choice B reason: This is the correct answer because this statement by the client indicates that the client does not understand the importance of a thorough evaluation by the surgeon prior to the procedure. Bariatric surgery is a major surgery that involves significant risks and benefits, and requires careful consideration of the client's medical history, physical condition, psychological status, and readiness for lifestyle changes. The surgeon should assess the client's eligibility, suitability, and expectations for the surgery, and provide informed consent and education.
Choice C reason: This is not the correct answer because this statement by the client indicates that the client understands the basic principles and types of bariatric surgery. Bariatric surgery can be classified into restrictive, malabsorptive, or combined procedures, depending on how they affect the size of the stomach and the absorption of food. The most common types of bariatric surgery are gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
Choice D reason: This is not the correct answer because this statement by the client indicates that the client understands the long-term implications and commitments of bariatric surgery. Bariatric surgery is not a quick fix or a magic solution for obesity, but rather a tool that helps the client achieve and maintain weight loss and improve health outcomes. The client should be aware that bariatric surgery requires lifelong changes in diet, exercise, medication, supplementation, and follow-up care.
Correct Answer is B
Explanation
Choice A reason: Environmental stress is not the correct answer. Environmental stress is caused by external factors that are beyond the person's control, such as noise, pollution, weather, or natural disasters. These factors can affect the person's physical and mental health, but they are not related to the person's specific situation or event.
Choice B reason: Situational stress is the correct answer. Situational stress is caused by a particular situation or event that the person faces, such as a test, a job interview, a conflict, or a loss. These situations or events can create pressure, uncertainty, or anxiety for the person, and they may require the person to adapt or cope with the change or challenge.
Choice C reason: Daily Hassle stress is not the correct answer. Daily Hassle stress is caused by the minor annoyances or frustrations that the person encounters in their everyday life, such as traffic, deadlines, bills, or household chores. These hassles can accumulate and affect the person's mood, health, or well-being, but they are not related to the person's specific situation or event.
Choice D reason: Episodic stress is not the correct answer. Episodic stress is caused by frequent or chronic exposure to stressful situations or events, such as work overload, financial problems, or family issues. These situations or events can create a constant state of worry, agitation, or distress for the person, and they may affect the person's physical and mental health. Episodic stress is not a type of stress, but rather a result of experiencing too much stress over a long period of time.
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