A nurse is assessing four clients. Which client requires interventions for dehydration?

Choice A reason: A 30-pack-year smoking history indicates COPD risk but not acute distress. Smoking is a chronic factor, not an immediate symptom requiring urgent assessment. Clients with active respiratory distress, like accessory muscle use, take priority due to immediate risks of hypoxia.

Choice B reason: A 52-year-old in a tripod position using accessory muscles indicates severe respiratory distress in COPD, reflecting hypoxia or hypercapnia. This posture and muscle use signal increased work of breathing, requiring immediate assessment to prevent respiratory failure, making this client the highest priority.

Choice C reason: Dependent edema and clubbed fingers in a 68-year-old suggest chronic COPD with possible cor pulmonale. These are chronic findings, not acute distress. Clients with immediate respiratory compromise, like accessory muscle use, take priority due to the risk of rapid decompensation.

Choice D reason: Chronic cough with thick secretions is common in COPD but less urgent than acute respiratory distress. Secretions contribute to airway obstruction, but tripod positioning and accessory muscle use indicate immediate hypoxia risk, requiring priority assessment over chronic symptoms.

Choice A reason: Urine specific gravity of 1.010 is normal (1.005–1.030), indicating adequate hydration. Dehydration elevates specific gravity (>1.030) due to concentrated urine, so this client does not show dehydration signs, making this an incorrect choice for requiring fluid replacement interventions.

Choice B reason: Weight gain of 2.6 lbs in 24 hours suggests fluid retention, not dehydration. This may indicate hypervolemia, possibly from heart or renal failure, requiring diuretics. Dehydration involves weight loss, making this client’s finding inconsistent with dehydration needing intervention.

Choice C reason: Hematocrit of 45% is normal (38–50% males, 36–46% females). Dehydration elevates hematocrit due to hemoconcentration from reduced plasma volume. Normal hematocrit does not indicate dehydration, making this client an incorrect choice for requiring dehydration-specific fluid interventions.

Choice D reason: A BUN of 24 mg/dL is elevated (normal 7–20 mg/dL), indicating dehydration, as reduced renal perfusion concentrates blood urea nitrogen. This reflects hypovolemia, requiring fluid replacement to restore renal function and prevent acute kidney injury, making this client the priority for dehydration intervention.