An elderly patient does not complain of thirst. What should the nurse do to assess that this patient is not dehydrated?
1. Ask the physician for an order to begin intravenous fluid replacement.
2. Ask the physician to order a chest x-ray.
3. Monitor serum osmolality level.
4. Ask the physician for an order for a brain scan.
Correct Answer: 3
The thirst mechanism declines with aging, which makes older adults more vulnerable to dehydration and hyperosmolality. The nurse should monitor the patient's serum osmolality level as a first step in determining hydration status before other detailed and invasive testing is done. It is inappropriate to seek an IV at this stage. There is no indication the patient is experiencing pulmonary complications, thus a chest x-ray is not indicated. There is no data to support the need for a brain scan.
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