An older patient with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment findings as being consistent with the diagnosis of dehydration? (Select all that apply.)
A) Confusion
B) Shortness of breath
C) Decreased skin elasticity
D) Increased blood urea nitrogen (BUN)
E) Adventitious lung sounds on auscultation
A, C, D
Feedback:
Confusion, decreased skin elasticity, and increased BUN are all associated with dehydration. Adventitious lung sounds and shortness of breath are not associated with dehydration but rather with overhydration.
You might also like to view...
A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode?
1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.
When evaluating the effectiveness of new or revised therapies for pain relief, the nurse should:
a. observe the patient performing activities of daily living. b. observe the patient's facial expressions. c. frequently assess subjective data. d. perform evaluation of outcome goals.
A child is prescribed dexmethylphenidate. When developing the teaching plan for the child and parents, the nurse instructs the parents to administer the drug at which time? Select all that apply
A) After breakfast B) Before breakfast C) After lunch D) Before lunch E) At bedtime
A patient had gastric surgery 10 days ago and continues to require gastric suction because of a paralytic ileus. The patient reports tingling in the fingers, has hypertonic reflexes,
and has a respiratory rate of 8 breaths per minute that are deep in nature. The nurse recognizes that these symptoms are consistent with which diagnosis? a. Respiratory alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Metabolic alkalosis