a nurse is assessing a client who has fluid volume excess which of the following findings should the nurse expect
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ATI LPN

LPN Fundamentals of Nursing Quizlet

1. A healthcare provider is assessing a client who has fluid volume excess. Which of the following findings should the healthcare provider expect?

Correct answer: C

Rationale: Crackles in the lungs are indicative of fluid accumulation in the alveoli, which is a characteristic finding in clients with fluid volume excess. The crackling sound occurs due to the presence of excess fluid in the lungs, impairing normal ventilation and gas exchange. Monitoring for crackles is essential for early detection and management of fluid overload in clients. Choices A, B, and D are incorrect because in fluid volume excess, hypervolemia leads to increased blood pressure (not hypotension), compensatory tachycardia (not bradycardia), and moist mucous membranes (not dry).

2. A healthcare provider is planning care for a client who has a pressure ulcer. Which of the following interventions should the healthcare provider include?

Correct answer: C

Rationale: Repositioning the client every 2 hours is a crucial intervention in the management of pressure ulcers. This action helps redistribute pressure, reducing the risk of further skin breakdown and promoting wound healing. Massaging the ulcer can cause further damage to the skin and underlying tissues. Applying a heating pad can increase the risk of skin breakdown and should be avoided. Alcohol-based cleansers are too harsh for pressure ulcers and can irritate the skin, potentially delaying healing.

3. A client with a new diagnosis of hypertension is being taught about lifestyle changes. Which of the following statements should the nurse include in the teaching?

Correct answer: A

Rationale: The correct statement to include in teaching a client with hypertension is to limit alcohol intake to no more than one drink per day. Excessive alcohol consumption can raise blood pressure and lead to complications. Increasing sodium intake, limiting physical activity, and avoiding dairy products are not recommended for managing hypertension. Clients with hypertension should follow a heart-healthy diet low in sodium, engage in regular physical activity, and monitor their blood pressure regularly to control hypertension effectively.

4. A client has tuberculosis, and the nurse is planning care. Which of the following isolation precautions should the nurse implement?

Correct answer: C

Rationale: The correct answer is C: Airborne. Tuberculosis is transmitted through the air, making it an airborne disease. Airborne precautions are crucial to prevent the spread of tuberculosis to others. These precautions include placing the client in a negative pressure room, wearing an N95 respirator mask, and ensuring proper ventilation to minimize the risk of transmission to healthcare workers and other clients. Choice A, Protective environment, is used for clients with compromised immune systems. Choice B, Contact precautions, are used for diseases spread by direct or indirect contact. Choice D, Droplet precautions, are for diseases transmitted through respiratory droplets, like influenza or pertussis.

5. A client with a new diagnosis of diverticulitis is being taught dietary management by a healthcare provider. Which of the following statements should the provider include in the teaching?

Correct answer: A

Rationale: Increasing intake of high-fiber foods is essential in managing diverticulitis as it promotes regular bowel movements and prevents constipation, reducing the risk of complications and improving overall digestive health. Choice B is incorrect because lactose intolerance is different from diverticulitis and avoiding lactose is not a standard recommendation for diverticulitis. Choice C is incorrect as decreasing high-fiber foods would be counterproductive for managing diverticulitis. Choice D is wrong because increasing dairy products is not a primary dietary recommendation for diverticulitis management.

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