A nurse is caring for a 68-kg (150-lb) client who has dehydration. Which of the following manifestations is an indication of effective treatment?

Urine specific gravity 1.005 to 1.030

Decreased pulse pressure

Lightheadedness

Urine output 75 mL in 1 hr

Answer and Explanation

The Correct Answer is D

The correct answer is D. Urine output 75 mL in 1 hr.

Adequate urine output (at least 30 mL/hr) indicates effective hydration, showing that the kidneys are functioning properly and fluid balance is improving. A urine output of 75 mL in 1 hour suggests sufficient fluid replacement.

Here’s why the other options are incorrect:

A. Urine specific gravity 1.005 to 1.030 – This range covers both normal and abnormal values. In dehydration, urine specific gravity is usually high (>1.030) due to concentrated urine. Effective treatment should lead to lower urine specific gravity, but the full range does not confirm improvement.
B. Decreased pulse pressure – Pulse pressure is the difference between systolic and diastolic blood pressure. Dehydration typically causes a narrowed pulse pressure, so improvement should lead to a normal or increased pulse pressure rather than a decrease.
C. Lightheadedness – Dizziness and lightheadedness are signs of dehydration-related hypotension. Effective hydration should resolve these symptoms, not maintain them.

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Correct Answer is A

Explanation

Choice A reason: Metastasis refers to the process by which cancer cells spread from the primary tumor site to distant organs or tissues. This can occur through the bloodstream or lymphatic system, leading to the formation of secondary tumors in other parts of the body.

Choice B reason: This statement is incorrect because metastasis, by definition, involves the spread of cancer cells to multiple locations, not their confinement to a single area.

Choice C reason: The description provided in this choice is more indicative of metaplasia, which is a change in the type of cells, and not metastasis, which is the spread of cancer cells.

Choice D reason: This choice is incorrect as it does not describe metastasis. Cancer cells do not stop growing because they run out of space; they continue to proliferate and can invade other tissues.

A. The client who had general anesthesia for back surgery 8 hours ago. B. The client who has a history of liver failure. C. The client who reported eating a diet high in calcium oxalate. D. The client who was treated with antibiotics for Staphylococcus aureus infection of the skin 2 weeks ago.

Correct Answer is A

Explanation

Choice A reason: General anesthesia can impair the autonomic nervous system, which controls bladder function, leading to urinary retention. This risk is particularly high shortly after surgery.

Choice B reason: While liver failure can lead to multiple organ dysfunction, it is not directly associated with urinary retention unless there are concurrent issues affecting the urinary system.

Choice C reason: A diet high in calcium oxalate can contribute to kidney stones, which could potentially cause urinary obstruction, but it is not a direct cause of urinary retention.

Choice D reason: Antibiotics for a skin infection would not typically lead to urinary retention unless there were an allergic reaction or other rare side effects that affect the urinary system.

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A nurse is caring for a 68-kg (150-lb) client who has dehydration. Which of the following manifestations is an indication of effective treatment?

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