A nurse is caring for a client who has a fluid and electrolyte imbalance. The nurse knows that the priority goal of taking care of this client is?

To obtain homeostasis

To prevent infection

To promote mobility

To enhance nutrition

Answer and Explanation

The Correct Answer is A

Choice A reason: Homeostasis is the body’s ability to maintain stable internal conditions, including fluid and electrolyte balance. Imbalances, like hypokalemia or hypernatremia, disrupt cellular function, potentially causing arrhythmias or neurological issues. Restoring homeostasis is the priority, as it addresses the root cause, ensuring proper organ function and preventing complications.

Choice B reason: Preventing infection is important but not the priority in fluid and electrolyte imbalances. Infections may occur secondary to other conditions, but the primary concern is correcting imbalances that affect cellular and organ function. Homeostasis must be achieved first to stabilize the client’s physiological state before addressing infection risks.

Choice C reason: Promoting mobility is relevant for overall health but not the priority in fluid and electrolyte imbalances. Imbalances can cause muscle weakness or arrhythmias, but restoring electrolyte levels takes precedence to ensure safe mobility. Without homeostasis, mobility efforts may be unsafe or ineffective due to physiological instability.

Choice D reason: Enhancing nutrition supports overall recovery but is secondary to correcting fluid and electrolyte imbalances. Nutritional deficiencies may contribute to imbalances, but the immediate goal is restoring homeostasis to prevent acute complications like cardiac or neurological dysfunction. Nutrition can be addressed once the client is stabilized.

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Correct Answer is D

Explanation

Choice A reason: The affective domain involves emotions and attitudes, such as valuing a diet’s importance. The client’s understanding of the diet’s role in recovery indicates knowledge, not emotional engagement. While they may value the diet, the question emphasizes understanding, which aligns with cognitive learning, not affective.

Choice B reason: The psychomotor domain involves physical skills, like preparing food or performing tasks. Following a nutritional chart accurately may involve actions, but the question highlights understanding the diet’s role in recovery, which is cognitive. Physical adherence is secondary to the mental comprehension described in the scenario.

Choice C reason: The interpersonal domain, not standard in learning taxonomies, may imply social skills. The client’s actions involve individual understanding and application of knowledge, not social interaction. The focus on understanding the diet’s impact on recovery points to cognitive learning, not interpersonal or social processes.

Choice D reason: The cognitive domain involves knowledge, comprehension, and application. The client’s ability to read, follow, and understand the nutritional chart’s role in recovery demonstrates cognitive learning. This includes processing information, understanding relationships, and applying knowledge to improve health outcomes, aligning with the scenario’s description of successful learning.

A. Urinary retention B. Decreased fluid volume risk C. Altered skin integrity D. Altered urinary elimination

Correct Answer is B

Explanation

Choice A reason: Urinary retention, the inability to empty the bladder, is unlikely with diuretics, which increase urine output. Diuretics reduce fluid volume by enhancing renal excretion, not causing retention. This concern is irrelevant, as the client’s increased output suggests effective diuresis, not bladder dysfunction or obstruction.

Choice B reason: Decreased fluid volume risk is a primary concern with diuretics, which increase urine output, potentially causing dehydration or electrolyte imbalances (e.g., hypokalemia). Education on fluid intake, monitoring weight, and recognizing dehydration symptoms is critical to prevent hypovolemia, ensuring safe diuretic use and maintaining physiological stability.

Choice C reason: Altered skin integrity may occur secondary to dehydration (dry skin) but is not the primary concern with diuretics. The main risk is fluid volume loss, which can lead to systemic complications like hypotension. Education should focus on fluid balance rather than skin, which is a secondary issue.

Choice D reason: Altered urinary elimination, such as incontinence, is not the primary concern, as diuretics increase output, not disrupt elimination patterns. While frequent urination may occur, the critical issue is fluid volume loss, which poses greater risks like dehydration or electrolyte imbalances, necessitating education on fluid management.

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A nurse is caring for a client who has a fluid and electrolyte imbalance. The nurse knows that the priority goal of taking care of this client is?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with quick recovery. In which domain is the client demonstrating successful learning?

Correct Answer is D

Explanation

A client is taking a diuretic that increases urinary output. What nursing concern is appropriate to base an educational plan?

Correct Answer is B

Explanation

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