The nursing diagnosis of Excess Fluid Volume is made for a patient with chronic kidney disease. Which of the following data is most important for the nurse to collect for this patient based on the nursing diagnosis?

daily weight

vital signs

intake and output

skin turgor

Answer and Explanation

The Correct Answer is C

A.   Daily weight monitoring is important for assessing fluid status but may not provide real-time information about fluid balance changes.
B.   Vital signs are important for overall assessment but may not specifically address the nursing diagnosis of Excess Fluid Volume unless there are significant changes indicative of fluid overload or dehydration.
C.   Monitoring intake and output provides direct information about fluid balance and renal function, helping to identify trends and assess the effectiveness of interventions aimed at managing fluid volume.
D.   Skin turgor assessment is useful for evaluating hydration status but may not provide comprehensive data on fluid volume excess alone.

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Correct Answer is C

Explanation

A. Nylon underwear can trap moisture and promote bacterial growth, increasing the risk of UTIs. Cotton underwear is recommended for better ventilation.
B. Delaying voiding can increase the risk of UTIs by allowing bacteria to multiply in the bladder. Voiding regularly and completely is important for flushing out bacteria.
C. Cranberry juice contains compounds that may help prevent UTIs by preventing bacteria from adhering to the urinary tract lining.
D. Douching can disrupt the natural balance of bacteria in the vagina and increase the risk of UTIs and other infections.

A. Bowel sounds B. Temperature C. Heart rate D. Skin integrity

Correct Answer is B

Explanation

A. While monitoring bowel sounds is important for assessing gastrointestinal function, it is not the most critical parameter to monitor in a patient with leukemia.
B. Fever can indicate infection, which is a common complication in patients with leukemia due to compromised immune function from the disease and its treatments.
C. Monitoring heart rate is important, but it may not be the most crucial parameter to monitor unless there are specific cardiac concerns.
D. Skin integrity should be monitored, but it may not be the most important parameter to monitor unless there are concerns about skin breakdown or infections.

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The nursing diagnosis of Excess Fluid Volume is made for a patient with chronic kidney disease. Which of the following data is most important for the nurse to collect for this patient based on the nursing diagnosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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