A nurse is assessing a client who is receiving IV furosemide for peripheral edema.
Which of the following findings should the nurse identify as an indication that the client is developing dehydration?
Urine output of 240 mL in a 12-hr period.
BUN 18 mg/dL (10 to 20 mg/dL).
Weight loss of 0.61 Kg (1.34 Ib) in 24 hr.
Blood pressure 100/70 mm Hg.
The Correct Answer is C
Choice A rationale
A urine output of 240 mL in a 12-hour period translates to 20 mL/hr, which is significantly below the normal physiological range of 30 mL/hr or greater. While low urine output can indicate dehydration, severe oliguria often points to acute kidney injury or severe hypovolemia, not solely dehydration. Normal urine output is generally considered to be 0.5-1 mL/kg/hr.
Choice B rationale
A BUN of 18 mg/dL falls within the normal range of 10 to 20 mg/dL. In dehydration, the kidneys reabsorb more water, leading to a disproportionate increase in BUN relative to creatinine due to increased urea concentration in the tubules, reflecting hypovolemia. A normal BUN value does not indicate dehydration.
Choice C rationale
A weight loss of 0.61 Kg (1.34 lb) in 24 hours is a significant and rapid reduction in body mass. This acute fluid deficit directly reflects a negative fluid balance, indicating a loss of body water. Each kilogram of weight loss approximates 1 liter of fluid loss, making this a clear indicator of dehydration due to fluid volume deficit.
Choice D rationale
A blood pressure of 100/70 mm Hg is within the normal range for many individuals, although it is on the lower side of normotension. While hypotension can be a late sign of severe dehydration, especially orthostatic hypotension, a reading of 100/70 mm Hg alone does not definitively confirm dehydration as the primary cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"},"G":{"answers":"A"}}
Explanation
- conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
- Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
- Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
- Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
- Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
- Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
- Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.
Correct Answer is C
Explanation
Choice A rationale
Metoprolol is a beta-blocker primarily used to treat hypertension, angina, and heart failure. It works by blocking beta-adrenergic receptors, leading to decreased heart rate and blood pressure. It is not indicated for managing tremors or dyskinesias associated with levodopa/carbidopa therapy in Parkinson's disease, as these are typically dopaminergic in origin.
Choice B rationale
Bethanechol is a muscarinic cholinergic agonist that increases bladder tone and stimulates gastrointestinal motility. It is primarily used for urinary retention and gastroesophageal reflux disease. Its mechanism involves directly stimulating muscarinic receptors. It has no role in addressing the motor complications like tremors and twitching seen with levodopa/carbidopa in Parkinson's disease.
Choice C rationale
Amantadine is an antiviral drug also used to treat dyskinesia associated with levodopa therapy in Parkinson's disease. Its precise mechanism of action in Parkinson's is not fully understood, but it is thought to modulate dopaminergic and glutamatergic neurotransmission. It can help reduce tremors, rigidity, and involuntary movements.
Choice D rationale
Gabapentin is an anticonvulsant and neuropathic pain medication. It is structurally related to GABA but does not act directly on GABA receptors. Its mechanism of action involves modulating calcium channels. While it can treat some neurological symptoms, it is not a primary treatment for levodopa-induced tremors and twitching in Parkinson's disease.
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