A nurse is caring for several clients with dehydration. The nurse assesses the client with which finding as needing oxygen therapy?*1 pointa. Tenting of skin on the back of the handb. Increased urine osmolarityc. Weight loss of 10 poundsd. Pulse rate of 115 beats/min

The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse?*1 pointa. Client behavior that changes from anxious to lethargicb. Deep furrows on the surface of the tonguec. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinchedd. Urine output of 950 mL for the past 24 hours

The nurse is assessing a client admitted with hyponatremia secondary to dehydration. Which of the following physical assessment findings would be expected?A. Orthostatic hypotensionB. Peaked T-waves on electrocardiogram (ECG)C. Bounding peripheral pulsesD. Polyuria

The nurse is performing an assessment on a client admitted to the hospital with a diagnosis of dehydration. Which assessment finding would the nurse expect to note?

A client weighed 210 lbs on admission to the hospital. After 2 days of diuretic therapy, the client weighs 205.5 lbs. The nurse could estimate that the amount of fluid that the client lost is:*1 pointA. 0.5 LB. 1.0 LC. 2.0 LD. 3.5 L28. You noted from the lab exams in the chart of M. Santos that he has reduced oxygen in the blood. This condition is called:*1 pointA. cyanosisB. hypoxiaC. hypoxemiaD. anemia29. To provide  safe, quality nursing care to various clients in any setting, the most important tool of the nurse is:*1 pointA. Critical thinking to decide appropriate nursing actionsB. Understanding of various nursing diagnosisC. Observations skills for data collectionD. Possession of scientific knowledge about client needs30. You are assigned to Mrs. Armado, age 49, who has admitted for possible surgery. She complained of recurrent paid at the right upper quadrant of the abdomen 1-2 hours after ingestion of fatty food. She also had frequent bouts of dizziness, blood pressure of 170/100, hot flashes. Which of the above symptoms would be an objective cue?*1 pointA. Blood pressure measurement of 170/100B. Complaint of hot flashesC. Report of pain after ingestion of fatty foodD. Complaint of frequent bouts of dizziness31. A client’s hypertension has recently diagnosed. The nurse would plan to do which of the following as the first step in teaching a client about the disorder?*1 pointA. gather all available resource materialB. plan for the evaluation of the sessionC. assess the client knowledge and needsD. decide on the teaching approach.32. Documentation and reporting are just important as providing patient care. As such, the nurse must be punctual and accurate to ensure quality documentation and reporting. Health care reports have different purposes. The availability of patients' record to all health team members demonstrates which of the following purposes:*1 pointA. educationB. vehicle for communicationC. legal documentationD. research33. In the ecologic model of health, it pertains to factors or stressors (biologic, chemical, physical), that by its presence or absence can lead to a disease.*1 pointA. AgentB. HostC. EnvironmentD. EcosystemSituation: Respiration is usually the first vital sign to be assessed more than anything for it is easily altered by the patient’s consciousness. The nurse should be aware of the different changes and alteration in respiration.34. Another name for an abnormal breath sound is:*1 pointA. adventurous breath soundsB. excursionC. adventitious breath soundsD. dyspnea35. In a client with Diabetic Ketoacidosis , Kussmauls respiration is exhibited. This evidence shows that there is the presence of:*1 pointA. Respiratory acidosisB. Metabolic acidosisC. Respiratory alkalosisD. Metabolic alkalosis36. If the nurse will auscultate the base of the lungs , it is expected that she will hear:*1 pointA. BronchovesicularB. TubularC. VesicularD. Crackles37. A 198 lbs patient sustained deep partial thickness burns with 22 % of body surface area affected. How much IV fluid is to be administered during the first 8 hours using Parkland formula of fluid resuscitation?*1 pointA. 7, 920 mlB. 3, 960 mlC. 1, 980 mlD. 950 ml38. Which of the following comprises transcellular fluid?*1 pointA. CytosolB. PlasmaC. Cerebrospinal fluidD. Serum39. Which of the following constitutes intracellular fluid?*1 pointA. PlasmaB. Synovial fluidC. Serous fluidD. Cytosol40. This refers to the pressure exerted by plasma proteins?*1 pointA. Hydrostatic PressureB. Oncotic PressureC. Negative PressureD. Atmospheric Pressure

Which item of assessment data obtained by the home care nurse suggests that an older adult client may be dehydrated?*1 pointa. The client has dry, scaly skin on bilateral upper and lower extremities.b. The client states that he gets up three or more times during the night to urinate.c. The client states that he feels lightheaded when he gets out of bed or stands up.d. The nurse observes tenting on the back of the hand when testing skin turgor.