Which patient has the highest risk of experiencing nocturia? The patient who:

Takes a sleeping pill at 9 pm.

Takes a diuretic at 7 pm.

Takes frequent naps during the day.

Takes a diuretic at 7 am. . .

Answer and Explanation

The Correct Answer is B

Choice A rationale

Taking a sleeping pill at 9 pm might influence nighttime voiding indirectly by affecting sleep patterns or bladder awareness, but it doesn't directly increase urine production. Sleeping pills primarily work on the central nervous system to promote sleep and are not known to have a diuretic effect that would lead to increased nighttime urination.

Choice B rationale

Taking a diuretic at 7 pm significantly increases the risk of nocturia because diuretics promote fluid excretion by the kidneys. This increased urine production will likely occur during the night, after the medication has been absorbed and metabolized, leading to the need to wake up to urinate. The peak effect of many diuretics occurs within a few hours of administration.

Choice C rationale

Taking frequent naps during the day is unlikely to be a direct cause of nocturia. While changes in daytime activity and fluid intake patterns could indirectly influence nighttime voiding, napping itself does not have a physiological mechanism that directly increases urine production specifically at night.

Choice D rationale

Taking a diuretic at 7 am is less likely to cause nocturia compared to taking it in the evening. By 7 pm, the diuretic's effect of increased urine production will likely have subsided for most individuals, allowing for more normal bladder function during the night. The majority of the diuresis will occur during the daytime hours. .

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Correct Answer is D

Explanation

Choice A rationale

Hypokalemia, a deficiency of potassium in the blood (normal range: 3.5-5.0 mEq/L), typically leads to metabolic alkalosis due to intracellular hydrogen ion shifts. While respiratory and metabolic acid-base balances are interconnected, hypokalemia itself does not directly cause the retention of carbon dioxide, which is the hallmark of respiratory acidosis.

Choice B rationale

A high fever increases the metabolic rate, leading to increased oxygen consumption and carbon dioxide production. However, the body usually compensates for this by increasing the respiratory rate to expel the excess carbon dioxide. Therefore, while fever affects gas exchange, it is more likely to cause respiratory alkalosis due to hyperventilation, not acidosis.

Choice C rationale

Extreme anxiety can lead to hyperventilation, causing an excessive exhalation of carbon dioxide and a subsequent decrease in the partial pressure of carbon dioxide in the arterial blood (PaCO2). This results in respiratory alkalosis, not respiratory acidosis, where the PaCO2 is elevated (normal range: 35-45 mmHg).

Choice D rationale

Sedative overdose depresses the central nervous system, including the respiratory center in the brainstem. This depression leads to a decrease in both the rate and depth of breathing (hypoventilation). Inadequate ventilation causes the retention of carbon dioxide, leading to an increase in PaCO2 and a decrease in blood pH (normal range: 7.35-7.45), resulting in respiratory acidosis.

A. Impaired Skin Integrity. B. Impaired Urinary Elimination. C. Urinary Retention. D. Risk for Deficient Fluid Volume.

Correct Answer is D

Explanation

Choice A rationale

Impaired Skin Integrity involves damage to the epidermal and/or dermal layers of the skin. While excessive fluid loss can indirectly affect skin turgor and increase the risk of breakdown over time, the primary and immediate physiological consequence of increased urinary output due to a diuretic is a potential reduction in overall fluid volume within the body, not a direct impairment of skin integrity.

Choice B rationale

Impaired Urinary Elimination describes difficulties in controlling or completely emptying the bladder. A diuretic, by its mechanism of action, increases urine production and thus promotes urinary elimination. While the *pattern* of elimination may change (increased frequency, urgency), the fundamental issue is not an impairment of the elimination process itself but rather an *increase* in it.

Choice C rationale

Urinary Retention is the inability to empty the bladder completely. A diuretic works to increase urine output, directly counteracting the physiological process of urinary retention. Therefore, this nursing diagnosis would be inappropriate for a client experiencing increased urinary output due to diuretic use.

Choice D rationale

Risk for Deficient Fluid Volume is a nursing diagnosis that identifies a vulnerability to a decrease in intravascular, interstitial, and/or intracellular fluid, which may compromise health. A diuretic increases urinary output, leading to a greater loss of fluid from the body. Without adequate fluid intake to compensate for this increased loss, the client is at a significant risk of developing a fluid volume deficit.

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