A nurse in a community clinic is collecting data from a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? (Select all that apply.)
(Select All that Apply.)
Bradycardia
Pale Yellow Urine
Poor Skin Turgor
Hypotension
Flat Neck Veins
Correct Answer : C,D,E
A. Bradycardia: Vomiting and diarrhea usually lead to tachycardia (increased heart rate) as the body compensates for hypovolemia, not bradycardia (slow heart rate).
B. Pale Yellow Urine: Dehydration often causes the urine to become concentrated and dark yellow, not pale yellow.
C. Poor Skin Turgor: Poor skin turgor is a classic sign of dehydration caused by fluid loss.
D. Hypotension: Loss of fluid volume can result in hypotension due to reduced blood circulation.
E. Flat Neck Veins: Dehydration causes reduced venous return, leading to flat neck veins, particularly when lying down.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Lactulose: Lactulose is used to treat hepatic encephalopathy by reducing ammonia levels, not for hyperkalemia.
B. Acetylcysteine: Acetylcysteine is used for acetaminophen overdose or as a mucolytic agent, not for hyperkalemia.
C. Sodium polystyrene (Kayexalate): Kayexalate is used to treat hyperkalemia by exchanging sodium for potassium in the intestines, promoting the elimination of potassium through the stool. This is the correct treatment for a potassium level of 6.8 mEq/L, which is dangerously high.
D. Triamterene: Triamterene is a potassium-sparing diuretic and would worsen hyperkalemia, not treat it.
Correct Answer is C
Explanation
A. Hematocrit 45% (37% to 52%): This value is within the normal range for hematocrit. Dehydration may increase the hematocrit due to a relative increase in red blood cell concentration, but 45% is still within normal limits.
B. Creatinine 0.9 mg/dL (0.5-1.2 mg/dL): This value is within the normal range for creatinine, indicating normal kidney function.
C. BUN 25 mg/dL (10-20 mg/dL): An elevated BUN level is a sign of dehydration as it reflects increased protein breakdown and decreased renal perfusion. This value is above the normal range and should be reported to the provider.
D. Urine specific gravity 1.028 (1.005 to 1.030): This value is within the normal range and indicates that the kidneys are concentrating urine, which is typical in dehydration as the body tries to conserve water.
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