A nurse is evaluating the effectiveness of IV fluid therapy for a client who has dehydration. Which of the following findings indicates improvement?

Decreased urine specific gravity.

Increased hematocrit level.

Decreased skin turgor.

Increased serum osmolarity.

Answer and Explanation

The Correct Answer is A

Choice A reason:

Decreased urine specific gravity indicates improvement in hydration status. Urine specific gravity is a measure of the concentration of solutes in the urine. It reflects the ability of the kidney to concentrate or dilute urine. A high urine specific gravity (>1.030) indicates concentrated urine, which can be caused by dehydration, reduced renal blood flow, or increased fluid loss. A low urine specific gravity (<1.010) indicates diluted urine, which can be caused by overhydration, diuretic use, or impaired renal function. A normal urine specific gravity ranges from 1.010 to 1.030.

Choice B reason:

Increased hematocrit level indicates worsening of dehydration. Hematocrit is the percentage of red blood cells in the total blood volume. It is affected by the plasma volume and the number of red blood cells. A high hematocrit (>47% for males and >42% for females) indicates hemoconcentration, which can be caused by dehydration, polycythemia, or hypoxia. A low hematocrit (<37% for males and <32% for females) indicates hemodilution, which can be caused by overhydration, anemia, or hemorrhage. A normal hematocrit ranges from 37% to 47% for males and 32% to 42% for females.

Choice C reason:

Decreased skin turgor indicates persistent dehydration. Skin turgor is the elasticity of the skin that reflects its hydration status. It is assessed by pinching a fold of skin on the chest, abdomen, or forearm and releasing it. Normally, the skin should return to its original position in less than 3 seconds. If the skin remains elevated or takes longer to return, it indicates poor skin turgor, which can be caused by dehydration, aging, or edema.

Choice D reason:

Increased serum osmolarity indicates worsening of dehydration. Serum osmolarity is a measure of the concentration of solutes in the blood plasma. It reflects the balance between water and electrolytes in the body fluids. A high serum osmolarity (>300 mOsm/kg) indicates hyperosmolarity, which can be caused by dehydration, hypernatremia, hyperglycemia, or mannitol infusion. A low serum osmolarity (<280 mOsm/kg) indicates hypoosmolarity, which can be caused by overhydration, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), or diuretic use. A normal serum osmolarity ranges from 280 to 300 mOsm/kg.

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Correct Answer is C

Explanation

Choice A reason: Sodium. Sodium is not affected by serum phosphate level in chronic kidney disease (CKD) patients. Sodium level is mainly regulated by the renin-angiotensin-aldosterone system and the antidiuretic hormone. Sodium level can be altered by fluid intake, fluid loss, diuretics, or salt restriction, but not by phosphate level.

Choice B reason:

Magnesium. Magnesium is also not affected by serum phosphate level in CKD patients. Magnesium level is mainly influenced by dietary intake, intestinal absorption, renal excretion, and exchange with bone and soft tissues. Magnesium level can be altered by malnutrition, malabsorption, diarrhea, vomiting, diuretics, or alcoholism, but not by phosphate level.

Choice C reason:

Calcium. Calcium is the correct answer because calcium and phosphate have an inverse relationship in the body. When serum phosphate level is elevated, as in CKD patients, serum calcium level tends to decrease. This is because high phosphate level binds to calcium and forms insoluble complexes that are deposited in soft tissues and bones. This reduces the amount of free calcium in the blood and triggers the secretion of parathyroid hormone (PTH), which further lowers the calcium level by increasing its excretion in the urine.

Choice D reason:

Bicarbonate. Bicarbonate is not directly affected by serum phosphate level in CKD patients. Bicarbonate level is mainly determined by the acid-base balance in the body. Bicarbonate level can be altered by metabolic acidosis or alkalosis, respiratory acidosis or alkalosis, renal failure, or diarrhea, but not by phosphate level.

A. The client reports increased thirst. B. The client's urine output is 250 mL/hr. C. The client's heart rate is 100/min. D. The client's weight is unchanged.

Correct Answer is B

Explanation

Choice A reason:

The client reports increased thirst. This is not an indication that the medication was effective, because increased thirst can be a sign of dehydration or electrolyte imbalance caused by excessive diuresis. Furosemide can cause loss of water and sodium, potassium, calcium, magnesium, and chloride in the urine.

Choice B reason:

The client's urine output is 250 mL/hr. This is an indication that the medication was effective, because furosemide is a loop diuretic that inhibits the reabsorption of sodium and water in the ascending limb of the loop of Henle, resulting in increased urine output and decreased fluid volume. A normal urine output is about 30 to 60 mL/hr, so a urine output of 250 mL/hr indicates a significant diuretic effect.

Choice C reason:

The client's heart rate is 100/min. This is not an indication that the medication was effective, because a high heart rate can be a sign of hypovolemia, hypotension, or cardiac stress caused by furosemide. Furosemide can lower the blood pressure and reduce the preload and afterload on the heart, but it can also trigger compensatory mechanisms such as increased sympathetic activity and renin-angiotensin-aldosterone system activation, which can increase the heart rate.

Choice D reason:

The client's weight is unchanged. This is not an indication that the medication was effective, because weight loss is expected with furosemide therapy due to fluid removal. Furosemide can cause a rapid and significant reduction in fluid volume, which can be measured by daily weight changes. A weight loss of 1 kg corresponds to a fluid loss of about 1 L.

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A nurse is evaluating the effectiveness of IV fluid therapy for a client who has dehydration. Which of the following findings indicates improvement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who has chronic kidney disease and notes that the serum phosphate level is elevated. The nurse should anticipate that which of the following electrolyte levels will be decreased?

Correct Answer is C

Explanation

A nurse is evaluating a client who has fluid volume overload and received furosemide 40 mg IV bolus 1 hr ago. Which of the following findings indicates that the medication was effective?

Correct Answer is B

Explanation

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