A nurse is caring for a client who has heart failure (HF). Which of the following should the nurse identify as a cause for the client's decreased serum osmolality?

A decrease in intracellular fluid volume

An increase in hydrostatic pressure

An increase in serum sodium

An increase in vascular fluid volume

Answer and Explanation

The Correct Answer is D

A. A decrease in intracellular fluid volume: A reduction in intracellular fluid volume often results from hypertonic conditions in the extracellular space, which can draw water out of cells. This shift can actually increase serum osmolality rather than decrease it.
B. An increase in hydrostatic pressure: Increased hydrostatic pressure promotes fluid movement from the vascular space into the interstitial tissues, contributing to edema. However, this does not significantly impact the concentration of solutes in the serum and therefore does not directly cause a decrease in osmolality.
C. An increase in serum sodium: Sodium is the main contributor to serum osmolality, so an increase in serum sodium raises osmolality. This is the opposite of what occurs in heart failure, where sodium levels are often diluted due to fluid retention.
D. An increase in vascular fluid volume: In heart failure, the kidneys retain fluid in response to decreased cardiac output, expanding the vascular volume. This excess water dilutes the concentration of solutes in the blood, such as sodium, leading to a decrease in serum osmolality.

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Correct Answer is B

Explanation

A. "Discussing organ donation with the family": While organ donation is important, it is not the priority in the setting of an actively dying client. The primary concern at this stage should be addressing the immediate needs of the client and their family, focusing on emotional support and comfort.
B. "Communicating sensitively with the client and family.": When caring for a client who is actively dying, providing emotional support and clear communication with the family is critical. Sensitively addressing the family’s concerns and the client’s comfort is essential in this stage of care.
C. "Creating a plan for pain relief, nutrition, and hydration.": While ensuring pain relief is important, in the context of an actively dying patient, the focus should primarily be on comfort rather than ongoing interventions like nutrition and hydration, which may no longer be beneficial.
D. "Contacting the family's spiritual advisor.": While spiritual support is valuable, it should not be the first priority. Ensuring the client’s comfort and providing emotional support to the family should be prioritized initially, and the spiritual advisor can be contacted afterward if desired.

A. Tachycardia B. Decreased body temperature C. Slow respiratory rate D. Hypotension

Correct Answer is A

Explanation

A. Tachycardia: Elevated T3 and T4 levels with suppressed TSH indicate hyperthyroidism, which increases metabolic rate and sympathetic nervous system activity. This often results in tachycardia due to increased cardiac demand and heightened sensitivity to catecholamines.
B. Decreased body temperature: Hyperthyroidism typically causes increased heat production and heat intolerance. Clients often feel warm or overheated, not cold, so a drop in body temperature would be unexpected.
C. Slow respiratory rate: Increased metabolism usually raises oxygen demand, leading to a normal or increased respiratory rate. A slow respiratory rate is not characteristic of hyperthyroid states.
D. Hypotension: Hyperthyroidism often causes systolic hypertension due to increased cardiac output. While some clients may experience normal blood pressure, persistent hypotension is not a common finding.

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A nurse is caring for a client who has heart failure (HF). Which of the following should the nurse identify as a cause for the client's decreased serum osmolality?

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