With which client should the nurse be most alert for the possibility of hypertonic dehydra-tion?
A. 52-year-old woman with excessive wound bleeding 4 hours after surgery
B. 55-year-old man with diabetes mellitus in ketoacidosis
C. 80-year-old woman with chronic heart failure
D. 60-year-old man with severe malnutrition
B
Hypertonic dehydration occurs when water loss from the extracellular fluid is greater than a proportionate electrolyte loss. The remaining ECF is hypertonic, causing fluid to move from the intracellular space to maintain circulating volume. Thus, the symptoms of hypovolemia are not present. Ketoacidosis contributes to excess water loss through the greatly increased respiratory rate and very little electrolyte is lost. In hemorrhage, whole blood with fluid and electrolytes is lost, causing isotonic dehydration. The fluid balance problem with heart failure is overhydration. Malnutrition causes the body fluid to be hypotonic from decreased protein and sodium levels.
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A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this client's teaching?
a. "You must clean around your catheter daily with soap and water." b. "Wash the vaginal weights with a 10% bleach solution after each use." c. "Operations to repair your bladder are available, and you can consider these." d. "Buy slacks with elastic waistbands that are easy to pull down."
A nurse is counseling a patient with an anxiety disorder by using cognitive therapy strategies
She gives the patient a homework assignment to keep a diary in which he records the symptoms of anxiety he experiences and the events that transpired just before the onset of symptoms. What is the rationale for this strategy? a. Keep the patient intellectually occupied to prevent dwelling on physiological phenomena. b. Link symptoms with precipitating events, which provides a basis for discussion and reframing. c. Anxiety gives rise to automatic, negative thoughts that must be identified and analyzed. d. Show the patient that certain events are the likely cause of his anxiety and should be avoided.
Dorsiflexion of the feet is assessed by instructing the patient to
a. point the toes toward the floor. c. turn the soles of the feet outward. b. point the toes toward the chest. d. turn the soles of the feet inward.
The nurse is caring for a postpartal client who is experiencing afterpains following the birth of her third child. Which of the following comfort measures should the nurse implement to decrease her pain? Select all that apply
1. Offer warm blankets for her abdomen. 2. Call the physician to report this finding. 3. Inform her that this is not normal, and she will need an oxytocic agent. 4. Massage the fundus of the uterus gently and observe lochia for clots. 5. Administer a mild analgesic at bedtime to ensure rest. Correct