Which of the following should the nurse monitor to determine if the client's heart failure is improving?
Intake and output
Vital signs
Urine specific gravity
Daily weights
The Correct Answer is D
Choice A reason: Intake and output help assess fluid balance but are less sensitive than daily weights for tracking fluid retention trends.
Choice B reason: Vital signs provide general status but do not specifically reflect fluid overload or cardiac function improvement.
Choice C reason: Urine specific gravity reflects hydration status but is not a direct indicator of heart failure improvement.
Choice D reason: Daily weights are the most reliable non-invasive method to monitor fluid retention and response to therapy in heart failure management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Holding insulin during illness can lead to hyperglycemia and diabetic ketoacidosis (DKA). Insulin should generally be continued unless otherwise directed.
Choice B reason: Illness increases metabolic stress and can cause unpredictable glucose fluctuations. Frequent monitoring helps detect and manage hyperglycemia or hypoglycemia early.
Choice C reason: Reducing glucose checks during illness is unsafe and increases the risk of complications.
Choice D reason: Checking protein levels is not part of standard sick day management for diabetes. Monitoring ketones and glucose is more relevant.
Correct Answer is B
Explanation
Choice A reason: Bronchoscopy is a diagnostic and therapeutic procedure, not a preventive intervention for atelectasis. It is used when obstruction or complications are suspected.
Choice B reason: Frequent turning and ambulation are foundational nursing interventions that promote lung expansion and reduce the risk of atelectasis. They are supported by clinical guidelines.
Choice C reason: Positive pressure ventilation may be used in critical care settings but is not standard for routine postoperative prevention unless the client is ventilated.
Choice D reason: Intermittent oxygen therapy does not directly prevent atelectasis. Oxygen may be used to treat hypoxemia but does not promote alveolar expansion.
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