A patient has had diarrhea for several days. What assessment will the nurse make to identify risks from the diarrhea?

Lung sounds

Activity level

Skin turgor

Heart sounds

Answer and Explanation

The Correct Answer is C

A. Lung sounds: While important for respiratory assessment, lung sounds are not directly affected by diarrhea or dehydration unless complications such as aspiration or infection develop, which are less common in this context.

B. Activity level: Changes in activity may occur due to weakness or fatigue caused by fluid and electrolyte imbalances, but this is a less specific and less immediate indicator of dehydration risk.

C. Skin turgor: Assessing skin turgor helps evaluate hydration status. Poor skin turgor indicates fluid loss and dehydration, which is a common risk with prolonged diarrhea and can lead to more serious complications if untreated.

D. Heart sounds: Heart sounds can reveal cardiac abnormalities, but they are not the primary focus in assessing dehydration. However, monitoring heart rate and rhythm can provide additional information about circulatory status in severe cases.

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Free Nursing Study Resources

Correct Answer is ["4","500"]

Explanation

Convert the client's weight from pounds (lb) to kilograms (kg)

Weight in kg = 165 lb / 2.2 lb/kg

= 75 kg

Maximum Daily Dosage:

Maximum daily dosage = 75 kg ´ 60 mg/kg/day

= 4,500 mg/day

A. Dissolve the thrombus B. Reestablish blood flow C. Reduce vein inflammation D. Inhibit clot formation

Correct Answer is D

Explanation

A. Dissolve the thrombus: Heparin does not have the ability to break down or dissolve existing blood clots. Instead, it works to prevent the clot from growing larger or new clots from forming. Clot dissolution is achieved by other medications such as thrombolytics.

B. Reestablish blood flow: While the ultimate goal is to restore proper circulation, Heparin itself does not actively reopen blocked vessels. It works by stopping further clot formation, which can indirectly help improve blood flow over time.

C. Reduce vein inflammation: Heparin is not an anti-inflammatory medication and does not reduce inflammation in the veins. Its primary function is anticoagulation to prevent clot propagation rather than treating inflammation directly.

D. Inhibit clot formation: Heparin acts as an anticoagulant by interfering with the blood clotting process, particularly thrombin and factor Xa, preventing new clots from forming and existing clots from getting bigger. This is the main therapeutic purpose in treating DVT.

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A patient has had diarrhea for several days. What assessment will the nurse make to identify risks from the diarrhea?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client weighs 165 lb. She has a medication prescribed with a maximum daily dosage of 60 mg/kg/day. What is the maximum number of milligrams this this client can receive/day? (TYPE NUMBERS ONLY: Round to nearest whole number, Use commas as appropriate.)

Correct Answer is ["4","500"]

Explanation

The nurse understands the purpose of Heparin (anticoagulant) therapy in treating deep vein thrombosis is to:

Correct Answer is D

Explanation

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be:

The nurse understands that patients who are continuously deprived of REM sleep are at highest risk for:

A WOCN is reviewing the wound healing process with a group of nurses on a unit. The WOCN should include in the information which of the following alterations for wound healing by secondary intention? (Select all that apply)

A patient is to have peak and trough levels drawn for a particular drug. The nurse explains to the patient that these drug blood levels are important to:

Medications that are taken by mouth (swallowed)

A nurse is assessing an older adult client who is experiencing age-related changes. Which of the following should the nurse expect?

The nurse is caring for a client with a diagnosis of heart failure. This admission is the client's third admission within 90 days. The nurse educates the client with the goal of preventing readmission. Which nursing activity for this client would represent tertiary level prevention?