A chemotherapy patient has gained 5 pounds in 2 days. Which assessment question by the nurse is most appropriate?
a. "Are you having difficulty sleeping at night?"
b. "How many calories a day do you con-sume?"
c. "Do you have dry mouth or feel thirsty?"
d. "How many times a day do you urinate?"
ANS: D
A rapid gain in weight usually indicates ECV excess if the person began with normal ECV. Ask-ing the patient about urination habits will illuminate whether the body is trying to excrete the ex-cess fluid, or if renal dysfunction is contributing to ECV excess. Difficulty sleeping at night can occur if the body builds up excessive fluid in the lungs; however, it could also mean that the pa-tient is getting up frequently to urinate, so the question is not specific enough. Caloric intake does not account for rapid weight changes. Dry mouth and thirst accompany ECV deficit, which would be associated with rapid weight loss.
You might also like to view...
The letter C is the ________ _______ of water on the Fahrenheit thermometer
Fill in the blank(s) with correct word
What should be examined as the best way to determine the effectiveness of a health care system?
A. How many resources are expended by the system B. The health of the population served C. The number of noncitizens who seek health care in the system D. Typical cost of routine primary care
The charge nurse is reviewing charting completed on clients in the maternal–child triage unit. Which entry requires immediate intervention?
1. Multipara at 32 weeks: "Oligohydramnios per ultrasound secondary to fetal renal agenesis." 2. Primipara at 41 weeks: "Client reports leaking clear fluid from her vagina for 7 hours." 3. Primipara at 24 weeks diagnosed with polyhydramnios: "Client reporting shortness of breath." 4. Multipara at 34 weeks diagnosed with oligohydramnios: "Cervix 6 cm, ?2 station, up to walk in hallway."
The Nurse Licensure Compact (NLC) allows for the recognition of a nurse's license in another state. Opponents of the NLC most often raise which criticism?
A) Multistate licensure can make it more difficult to discover and enforce disciplinary actions against nurses. B) The standards of nursing practice vary greatly between different states and territories. C) Multistate licensure makes it more expensive for nurses to renew their licenses when they expire. D) It is difficult for nurses to obtain liability insurance when they are involved in work that spans more than one state.