A client is taking a diuretic that increases her urinary output.
What would be an appropriate nursing diagnosis on which to base an educational plan?
Impaired Skin Integrity.
Impaired Urinary Elimination.
Urinary Retention.
Risk for Deficient Fluid Volume.
The Correct Answer is D
Choice A rationale
Impaired Skin Integrity involves damage to the epidermal and/or dermal layers of the skin. While excessive fluid loss can indirectly affect skin turgor and increase the risk of breakdown over time, the primary and immediate physiological consequence of increased urinary output due to a diuretic is a potential reduction in overall fluid volume within the body, not a direct impairment of skin integrity.
Choice B rationale
Impaired Urinary Elimination describes difficulties in controlling or completely emptying the bladder. A diuretic, by its mechanism of action, increases urine production and thus promotes urinary elimination. While the *pattern* of elimination may change (increased frequency, urgency), the fundamental issue is not an impairment of the elimination process itself but rather an *increase* in it.
Choice C rationale
Urinary Retention is the inability to empty the bladder completely. A diuretic works to increase urine output, directly counteracting the physiological process of urinary retention. Therefore, this nursing diagnosis would be inappropriate for a client experiencing increased urinary output due to diuretic use.
Choice D rationale
Risk for Deficient Fluid Volume is a nursing diagnosis that identifies a vulnerability to a decrease in intravascular, interstitial, and/or intracellular fluid, which may compromise health. A diuretic increases urinary output, leading to a greater loss of fluid from the body. Without adequate fluid intake to compensate for this increased loss, the client is at a significant risk of developing a fluid volume deficit.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While reporting communicable diseases is a public health responsibility, it is typically mandated by law and health regulations, not specifically a requirement that nurses *always* report to the Board of Nursing in Texas. Reporting protocols usually involve health departments.
Choice B rationale
Parents declining treatment for a child can raise ethical and legal concerns, potentially involving child protective services or the legal system, but it is not always a direct reporting requirement to the Texas Board of Nursing unless it involves professional misconduct by a nurse.
Choice C rationale
A patient's decision to leave against medical advice is a matter of patient autonomy. While nurses document this and ensure the patient understands the risks, it is not typically a mandatory reporting situation to the Texas Board of Nursing unless there are specific concerns about the nurse's conduct related to the discharge.
Choice D rationale
Abuse of older adults by another nurse directly involves the professional conduct and potential harm caused by a licensed nurse. The Texas Board of Nursing is responsible for regulating nursing practice and ensuring patient safety, making it mandatory for nurses to report such instances of misconduct by a colleague.
Correct Answer is C
Explanation
Choice A rationale
High blood urea nitrogen (BUN) levels primarily indicate impaired kidney function or dehydration, as urea is a waste product of protein metabolism filtered by the kidneys. While severe protein catabolism can elevate BUN, it is not the most direct or sensitive indicator of inadequate protein intake. Normal BUN ranges typically fall between 7 to 20 mg/dL.
Choice B rationale
Low specific gravity of urine suggests that the kidneys are excreting dilute urine, which can be caused by various factors such as excessive fluid intake, diabetes insipidus, or kidney dysfunction. It is not a reliable indicator of protein nutritional status. Normal urine specific gravity ranges from 1.005 to 1.030.
Choice C rationale
Serum albumin is a protein synthesized by the liver and is a key indicator of long-term protein status. Inadequate protein intake leads to decreased albumin synthesis, resulting in low serum albumin levels. Albumin has a relatively long half-life (around 20 days), making it a reflection of chronic protein deficiency. Normal serum albumin levels typically range from 3.5 to 5.0 g/dL.
Choice D rationale
Hemoglobin is the protein in red blood cells responsible for oxygen transport. While severe protein deficiency can eventually affect hemoglobin levels due to the protein component, it is not the most direct or immediate indicator of inadequate protein intake. Other factors like iron deficiency are more commonly associated with low hemoglobin. Normal hemoglobin ranges for adults are typically 13.5 to 17.5 g/dL for males and 12.0 to 15.5 g/dL for females.
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