A client with ascites is at risk of developing fluid and electrolyte imbalances. Which nursing intervention should be implemented to monitor the client's fluid balance and hydration status effectively?
Weigh the client daily and record the weight in the chart.
Measure vital signs every four hours to assess for changes.
Assess urine output hourly and document the findings.
Restrict fluid intake to prevent further fluid retention.
The Correct Answer is A
Choice A reason:
This statement is correct. Weighing the client daily and recording the weight in the chart is an essential intervention to monitor fluid balance and detect any changes in body weight, which can indicate fluid retention or loss.
Choice B reason:
Measuring vital signs every four hours is important for assessing the client's overall condition, but it does not directly monitor fluid balance or hydration status.
Choice C reason:
Assessing urine output hourly is important, especially for clients with ascites who may have altered kidney function. However, it may not provide a comprehensive assessment of the client's overall fluid balance.
Choice D reason:
Restricting fluid intake may not be appropriate for all clients with ascites, as fluid restriction could lead to dehydration and further imbalances in fluid and electrolyte levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
This statement is correct. Weighing the client daily and recording the weight in the chart is an essential intervention to monitor fluid balance and detect any changes in body weight, which can indicate fluid retention or loss.
Choice B reason:
Measuring vital signs every four hours is important for assessing the client's overall condition, but it does not directly monitor fluid balance or hydration status.
Choice C reason:
Assessing urine output hourly is important, especially for clients with ascites who may have altered kidney function. However, it may not provide a comprehensive assessment of the client's overall fluid balance.
Choice D reason:
Restricting fluid intake may not be appropriate for all clients with ascites, as fluid restriction could lead to dehydration and further imbalances in fluid and electrolyte levels.
Correct Answer is B
Explanation
Choice A reason:
Increased urine output and dehydration are not typical findings in clients with ascites. Ascites involves fluid accumulation in the abdominal cavity, not fluid loss through the urinary system.
Choice B reason:
This statement is correct. Visible abdominal swelling and distention are characteristic signs of ascites, indicating the accumulation of fluid in the abdominal cavity.
Choice C reason:
Dry, cracked skin and itching are not specific to ascites and may be related to other conditions such as skin disorders or dehydration.
Choice D reason:
Rapid and irregular heart rate is not directly related to ascites. It may be associated with other conditions such as heart disease or infection.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.