A nurse reviews the urinalysis results of a patient and notes a urine osmolality of 1200 mOsm/kg (1200 mmol/kg). Which action would the nurse take?
Encourage the patient to drink more fluids.
Prepare to administer an intravenous diuretic.
Obtain a suction device and implement seizure precautions.
Contact the primary health care provider to recommend a low-sodium diet.
The Correct Answer is A
Choice A rationale
A urine osmolality of 1200 mOsm/kg (1200 mmol/kg) is high and indicates highly concentrated urine. The normal range for urine osmolality is typically 500 to 800 mOsm/kg (500 to 800 mmol/kg) but can range from 300 to 1300 mOsm/kg depending on hydration status. A high reading suggests the patient is dehydrated and the kidneys are conserving water. Therefore, encouraging the patient to drink more fluids is the appropriate intervention to restore hydration and lower urine concentration.
Choice B rationale
Administering an intravenous diuretic would worsen the patient's dehydration. Diuretics promote fluid excretion from the kidneys, which would further concentrate the urine and deplete the body's fluid volume. This action is contraindicated and potentially dangerous in a patient who is already dehydrated, as indicated by the high urine osmolality.
Choice C rationale
Seizure precautions are not indicated based on this laboratory result alone. While severe electrolyte imbalances, such as hyponatremia or hypernatremia, can cause seizures, a high urine osmolality primarily reflects dehydration and concentrated urine. It does not directly indicate an electrolyte imbalance severe enough to cause neurological symptoms, and there is no information to suggest this.
Choice D rationale
Recommending a low-sodium diet is not the primary intervention. While high sodium intake can contribute to fluid imbalance, the immediate concern is the high urine concentration, which indicates dehydration. The most direct and effective action to address dehydration is to increase fluid intake. A low-sodium diet is not the immediate solution for this specific finding and is not a priority at this time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A ham sandwich on white bread and carbonated beverages are low in fiber and can contribute to constipation. White bread is a refined grain, which lacks the dietary fiber found in whole grains. Carbonated drinks can cause gas and bloating. Applesauce contains some fiber, but it is not enough to offset the low-fiber choices, indicating a lack of understanding.
Choice B rationale
Grilled cheese on white bread is low in fiber. While a small banana contains some dietary fiber, it is often insufficient to promote effective elimination, and a grilled cheese sandwich lacks the roughage needed for bowel regularity. The combination of choices suggests the patient has not grasped the importance of a high-fiber diet.
Choice C rationale
Baked tilapia is a good source of protein, and fresh green beans are a good source of fiber. However, a cup of coffee is a diuretic and can lead to dehydration if not balanced with sufficient fluid intake, which can worsen constipation. The patient's selection shows a partial understanding but is not the most optimal choice for promoting elimination.
Choice D rationale
This selection indicates a correct understanding of dietary teaching. Broiled chicken provides protein, while brown rice and steamed broccoli are excellent sources of dietary fiber. Fiber adds bulk to the stool and helps to regulate bowel movements. The glass of apple juice provides additional fluid, which is essential for preventing constipation.
Correct Answer is C
Explanation
Choice A rationale
Assessing the patient's voice is important for detecting potential laryngeal nerve damage during the surgery, which is a risk of total thyroidectomy. However, this is a monitoring action. The most critical, immediate concern post-operatively is related to preventing injury and managing potential airway compromise, which is more directly addressed by other interventions.
Choice B rationale
Encouraging the patient to ambulate postoperatively is important for preventing complications such as deep vein thrombosis and pneumonia. However, it is not the highest priority intervention immediately following a thyroidectomy, which is focused on preserving the integrity of the surgical site and preventing neck strain.
Choice C rationale
After a total thyroidectomy, the most critical intervention is to avoid extending the patient's neck. This is to prevent tension and stress on the surgical incision and sutures, which could lead to wound dehiscence or bleeding. This also protects the airway and prevents pressure on the trachea or recurrent laryngeal nerves.
Choice D rationale
Administering oxygen as needed is a valid intervention, particularly if the patient has signs of respiratory distress, which is a potential complication of neck surgery. However, maintaining the neck in a neutral, non-extended position is a foundational and continuous priority to prevent direct trauma to the surgical site and the structures within.
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