A client is experiencing symptoms of fluid overload.
Which of the following interventions would the nurse anticipate as appropriate for this client?
Administering a diuretic medication.
Encouraging increased fluid intake.
Providing a high-sodium diet.
Elevating the affected extremities.
The Correct Answer is A
Fluid overload, also called hypervolemia, is a condition in which the body has too much water.
It can cause edema, hypertension, shortness of breath, and cardiovascular problems.
Diuretics are medications that help the body remove excess fluid through urine.
They are commonly used to treat fluid overload caused by heart failure, kidney failure, cirrhosis, and other conditions.
Choice B is wrong because encouraging increased fluid intake would worsen the fluid overload and increase the risk of complications.
Choice C is wrong because providing a high-sodium diet would also worsen the fluid overload and increase the risk of complications.
Sodium is an electrolyte that regulates fluid balance in the body.
Excess sodium intake can cause water retention and increase blood pressure.
Choice D is wrong because elevating the affected extremities is not an appropriate intervention for fluid overload.
Elevating the extremities can help reduce swelling caused by local factors such as injury or inflammation, but it does not address the underlying cause of fluid overload.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Furosemide is a diuretic that lowers blood pressure by increasing urine output and reducing fluid volume in the body.
One of the possible adverse effects of furosemide is hypotension, which is low blood pressure.
This can cause symptoms such as dizziness, faintness, confusion, or weakness.
The nurse should monitor the client’s blood pressure and report any signs of hypotension to the doctor.
Choice A is wrong because hypertension, which is high blood pressure, is not a common side effect of furosemide.
In fact, furosemide is used to treat hypertension in some cases.
Choice B is wrong because hypoglycemia, which is low blood sugar, is not a common side effect of furosemide.
Furosemide does not affect blood sugar levels directly.
However, it may interact with some medications that lower blood sugar, such as insulin or oral antidiabetic drugs.
The nurse should check the client’s medication history and monitor their blood sugar levels if they are taking any of these drugs.
Choice C is wrong because hyperkalemia, which is high potassium levels in the blood, is not a common side effect of furosemide.
Furosemide belongs to a class of diuretics called loop diuretics, which lower potassium levels by increasing its excretion in the urine.
One of the possible adverse effects of furosemide is hypokalemia, which is low potassium levels in the blood.
This can cause symptoms such as muscle cramps, weakness, irregular heartbeat, or numbness.
The nurse should monitor the client’s potassium levels and advise them to eat foods rich in potassium, such as bananas, oranges, or potatoes.
Normal ranges for blood pressure are 90/60 mmHg to 120/80 mmHg.
Normal ranges for blood sugar are 4.0 mmol/L to 7.8 mmol/L (72 mg/dL to 140 mg/dL).
Normal ranges for potassium are 3.5 mmol/L to 5.0 mmol/L (3.5 mEq/L to 5.0 mEq/L).
Correct Answer is D
Explanation
Protein intake can increase the excretion of calcium and oxalate in the urine, which can promote the formation of calcium oxalate stones. The client should limit animal protein sources, such as meat, poultry, fish, eggs, and dairy products.
Choice A is wrong because purine-rich foods, such as organ meats, shellfish, and beer, can increase the production of uric acid, which can cause uric acid stones.
Choice B is wrong because a low-calcium diet can increase the absorption of oxalate in the intestine, which can increase the risk of calcium oxalate stones.
The client should consume a moderate amount of calcium from dietary sources, such as milk, cheese, yogurt, and green leafy vegetables.
Choice C is wrong because potassium-rich foods, such as bananas, oranges, potatoes, and tomatoes, can help prevent calcium oxalate stones by increasing the urinary pH and citrate levels.
The client should consume adequate amounts of potassium from dietary sources.
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