A nurse is collecting data for a client who is receiving enteral tube feedings. The nurse should identify that which of the following findings is a manifestation of fluid overload?
Weight loss
Decreased blood pressure
Crackles heard in the lungs
Decreased skin turgor
The Correct Answer is C
Fluid overload refers to an excess volume of fluid in the body, which can occur as a result of various factors, including excessive fluid intake or inadequate fluid removal. Crackles heard in the lungs, also known as rales, can indicate fluid accumulation in the lungs, a condition known as pulmonary edema. It is a common manifestation of fluid overload and can be detected through auscultation of the lungs.

Weight loss is typically associated with inadequate calorie or nutrient intake, rather than fluid overload.
Weight loss is typically associated with inadequate calorie or nutrient intake, rather than fluid overload.
Weight loss is typically associated with inadequate calorie or nutrient intake, rather than fluid overload.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Correct answer: A
Option A is correct.In this scenario, the social worker is likely involved in the client's care plan and needs the medical information to provide appropriate support services.Involuntary commitment: In cases of involuntary commitment, there might be a court order allowing for information sharing to ensure the client's well-being..
Option B is incorrect because sharing client information with a client's employer is generally not appropriate without the client's explicit consent. Confidentiality must be maintained, and any concerns about safety due to substance use should be discussed with the client and appropriate healthcare professionals.
Option C is incorrect.Sharing information with a nurse from another unit after a client commits suicide is generally not appropriate unless: there is a specific reason for sharing, such as identifying potential risks to other clients, the minimum amount of information necessary is shared and the sharing complies with HIPAA (Health Insurance Portability and Accountability Act) regulations.
Option D is incorrect because sharing client information with a client's partner after the client reports intimate partner abuse could potentially compromise the client's safety. It is crucial to follow specific protocols and laws related to reporting abuse while ensuring the client's confidentiality and well-being.
Correct Answer is A
Explanation
Observing the client during and after meals is crucial for monitoring their eating behaviors, identifying any signs of bingeing or purging, and assessing their overall progress in managing their eating disorder. By closely observing the client, the nurse can provide immediate support and intervention if necessary and help prevent or address any potentially harmful behaviors. Instructing the client about effective coping strategies is valuable in helping them develop healthier ways to manage stress and emotions. However, this instruction can be more effective once the nurse has observed the client's behaviors and identified specific areas where coping strategies are needed.
Suggesting that the client assist with meal planning can be a helpful step in empowering them to take ownership of their eating habits and make healthier choices. However, before involving the client in meal planning, it is important to first assess their current eating behaviors and address any immediate concerns or risks.
Referring the client to a support group for individuals with eating disorders is a beneficial step in providing ongoing support and community. However, this referral can be made once the nurse has established a baseline understanding of the client's behaviors and needs.
Observing the client during and after meals is crucial for monitoring their eating behaviors, identifying any signs of bingeing or purging, and assessing their overall progress in managing their eating disorder. By closely observing the client, the nurse can provide immediate support and intervention if necessary and help prevent or address any potentially harmful behaviors. Instructing the client about effective coping strategies is valuable in helping them develop healthier ways to manage stress and emotions. However, this instruction can be more effective once the nurse has observed the client's behaviors and identified specific areas where coping strategies are needed.
Suggesting that the client assist with meal planning can be a helpful step in empowering them to take ownership of their eating habits and make healthier choices. However, before involving the client in meal planning, it is important to first assess their current eating behaviors and address any immediate concerns or risks.
Referring the client to a support group for individuals with eating disorders is a beneficial step in providing ongoing support and community. However, this referral can be made once the nurse has established a baseline understanding of the client's behaviors and needs.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
