A physician has prescribed vasopressin to the client for regulating the reabsorption of water by the kidneys. Which of the following assessments should the nurse perform after the administration of vasopressin?
A) Observe for and report any evidence of edema, such as dyspnea.
B) Measure and record the client's abdominal girth every hour.
C) Observe the client for blanching of the skin, abdominal cramps, and nausea.
D) Weigh the client every day to obtain a baseline weight.
Ans: C
Feedback:
After vasopressin is administered to the client, the nurse should observe the client every 10 to 15 minutes for signs of an excessive dosage, which include blanching of the skin, abdominal cramps, and nausea. After corticotropin is administered to the client, the nurse needs to observe for and report any evidence of edema, such as weight gain, rales, increased pulse or dyspnea, or swollen extremities. If the client is receiving vasopressin for abdominal distention, the nurse needs to auscultate the abdomen every 15 to 30 minutes and measure abdominal girth hourly. The nurse needs to weigh the client to obtain a baseline weight for future comparison before administering vasopressin to the client.
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