The nurse notes that the client's weight today is 2 pounds less than yesterday. Which should the nurse implement to assess the weight loss?

Question

1. Verify calibration of the scale before next weight.
2. Weigh the client again this evening for comparison.
3. Instruct client to empty the bladder before each weight.
4. Collaborate with dietitian to increase client caloric intake.

Answer 1

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3. The nurse needs to determine whether the weight loss is due to loss of fluid or to loss of body mass because the nursing care for each problem is different. A 2-pound weight loss is probably due to fluid loss because most clients, even when adhering to a very strict weight-loss program, cannot lose 2 pounds overnight; however, it is rela-tively easy to excrete 2 pounds of fluid by limiting sodium intake or using diuretic therapy.
1. The nurse calibrates the scale before weighing any client once a day.
2. Weighing the client for a second time is likely to be unreliable if the client has re-ceived food and fluids that increase the body weight but do not represent a true client weight.
4. The nurse needs to gather more information before concluding the client's weight loss is due to loss of body mass and not from fluid loss.