A nurse is caring for four hospitalized patients.
Which of the following patients should the nurse identify as being at risk for fluid volume deficit?
The patient who has left-sided heart failure and has a brain natriuretic peptide (BNP) level of 600 pg/mL.
The patient who has been NPO since midnight for endoscopy.
The patient who has gastroenteritis and is febrile.
The patient who has end-stage renal failure and is scheduled for dialysis today.
The Correct Answer is C
Choice A rationale
While heart failure can lead to fluid volume imbalances, a BNP level of 600 pg/mL alone does not indicate a risk for fluid volume deficit.
Choice B rationale
Being NPO since midnight for an endoscopy could potentially lead to fluid volume deficit, but it’s not the most likely choice. Typically, patients are adequately hydrated before and after the procedure.
Choice C rationale
A patient with gastroenteritis and a fever is at high risk for fluid volume deficit. Gastroenteritis can cause significant fluid loss through vomiting and diarrhea, and fever increases insensible water loss.
Choice D rationale
While patients with end-stage renal failure can have fluid volume imbalances, they are more likely to experience fluid volume excess, especially if they are due for dialysis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Hepatitis A is primarily transmitted through fecal contamination of food or water. This can occur when an infected person does not wash their hands properly after going to the bathroom and then touches food or other objects that others then put in their mouths.
Choice B rationale
While sexual intercourse can potentially transmit Hepatitis A, it is not the primary mode of transmission. The risk is higher if the sexual activity involves oral-anal contact.
Choice C rationale
Kissing mouth-to-mouth is not typically a primary mode of Hepatitis A transmission unless fecal particles are somehow involved.
Choice D rationale
Contact with infected blood is not the primary mode of Hepatitis A transmission. Hepatitis A is primarily spread through the fecal-oral route, not through blood.
Correct Answer is A
Explanation
Choice A rationale
Anemia due to excessive blood loss during surgery can lead to a variety of symptoms. One of the most common symptoms is fatigue. This is because anemia results in a decrease in the amount of oxygen that can be delivered to the body’s tissues, leading to a lack of energy and feelings of exhaustion. Therefore, a nurse should expect to find fatigue in a postoperative client who has anemia due to excessive blood loss during surgery.
Choice B rationale
Bradycardia, or a slower than normal heart rate, is not typically associated with anemia. Instead, anemia can actually lead to tachycardia, or a faster than normal heart rate, as the body tries to compensate for the decreased oxygen carrying capacity of the blood.
Choice C rationale
Hypertension, or high blood pressure, is not a typical finding in patients with anemia. In fact, in severe cases, anemia can lead to hypotension, or low blood pressure, due to a decrease in the blood’s ability to carry oxygen.
Choice D rationale
Diarrhea is not a common symptom of anemia. Anemia due to excessive blood loss during surgery is more likely to result in symptoms related to a lack of oxygen in the body’s tissues, such as fatigue, weakness, and shortness of breath.
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