A nurse is caring for a client who has fluid volume deficit and is receiving intermittent IV fluid replacement therapy. Which of the following findings should the nurse identify as an indication the treatment has been effective?
Decrease in blood pressure
Increase in heart rate
Increase in urine output
Decrease in dependent edema
The Correct Answer is C
A. Decrease in blood pressure is not a positive indicator in this case; an increase in blood pressure is desired with effective treatment.
B. An increase in heart rate typically indicates dehydration or fluid deficit, not improvement.
C. An increase in urine output is a positive sign of fluid balance restoration. It shows the kidneys are functioning effectively with sufficient hydration.
D. Dependent edema might not decrease immediately, and its presence may not indicate the fluid therapy's effectiveness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Expired medications should be returned to the pharmacy for proper disposal or replacement.
B. Expired medications should not be placed back in the medication cart, as they may not be safe for administration.
C. Flushing medications down the toilet is not recommended, as it can affect the environment.
D. Notifying the provider is unnecessary unless the expired medications are essential for the client's treatment.
Correct Answer is A
Explanation
A. Dark stools could indicate gastrointestinal bleeding, a known side effect of enoxaparin, and should be reported immediately.
B. Enoxaparin should be injected subcutaneously, not into a muscle.
C. Enoxaparin is an anticoagulant and does not directly decrease bleeding; rather, it prevents blood clot formation.
D. Enoxaparin should be injected at a 90-degree angle into the subcutaneous tissue.
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