Multiple Choice
The nurse is assessing a client who has been vomiting for 2 days and has not been able to eat or drink anything during this time. The client's mucous membranes are dry, there is decreased skin turgor, and the client complains of weakness. The client's vital signs are blood pressure (BP) 80/52; temperature (T) = 99.6°F (37.6°C) orally; pulse (P) = 110 beats/min, weak and thready. Her skin and mucous membranes are dry, and there is decreased skin turgor. The following are the laboratory results:
Sodium
138 mEq/L
Potassium
3.7 mEq/L
Calcium
9.2 mg/dL
Magnesium
1.8 mg/dL
Chloride
99 mEq/L
Blood urea nitrogen (BUN)
29 mg/dL
Which of the following is an appropriate nursing diagnosis for this client?
A) Impaired Gas Exchange related to ineffective breathing
B) Excess Fluid Volume related to limited fluid output
C) Deficient Fluid Volume related to abnormal fluid loss
D) Electrolyte Imbalance related to decreased oral intake
Correct Answer:
Verified
Correct Answer:
Verified
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