Which is the most reliable method for monitoring improvement when restoring fluid balance?
Vital signs
skin turgor
Daily input and output
Daily weights
The Correct Answer is D
A. Vital signs: Vital signs can reflect changes in fluid status, but they are not always sensitive to small shifts in fluid balance and can be affected by many other factors like medications.
B. Skin turgor: Skin turgor can be useful for assessing dehydration but is not a reliable indicator for tracking fluid balance over time, especially in older adults where skin elasticity naturally declines.
C. Daily input and output: Monitoring intake and output is useful, but it is not the most reliable for evaluating overall fluid balance, especially in cases of insensible loss or shifts in third spaces.
D. Daily weights: Weighing the patient daily is the most reliable method for monitoring fluid balance because it directly reflects changes in fluid retention or loss, particularly in acute or chronic conditions like heart failure or dehydration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Weak pulse: Isotonic fluid-volume deficit results in decreased blood volume, leading to reduced cardiac output and a weak, thready pulse.
B. Distended neck veins: This is associated with fluid volume excess, not deficit.
C. Bradycardia: Fluid deficit typically leads to tachycardia as the body compensates for decreased circulating volume.
D. Pitting edema: This is a sign of fluid overload rather than deficit.
Correct Answer is C
Explanation
A. Hematocrit 45% (37% to 52%): This value is within the normal range for hematocrit. Dehydration may increase the hematocrit due to a relative increase in red blood cell concentration, but 45% is still within normal limits.
B. Creatinine 0.9 mg/dL (0.5-1.2 mg/dL): This value is within the normal range for creatinine, indicating normal kidney function.
C. BUN 25 mg/dL (10-20 mg/dL): An elevated BUN level is a sign of dehydration as it reflects increased protein breakdown and decreased renal perfusion. This value is above the normal range and should be reported to the provider.
D. Urine specific gravity 1.028 (1.005 to 1.030): This value is within the normal range and indicates that the kidneys are concentrating urine, which is typical in dehydration as the body tries to conserve water.
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