When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient™s fluid volume status?

Correct Answer: C

Rationale: In the context of a patient receiving diuretic therapy, assessing fluid volume status is crucial for monitoring their response to treatment and preventing potential complications. The best measure to reflect the patient's fluid volume status among the options provided is C) Intake, output, and daily weight. Intake and output measurements are essential indicators of fluid balance in the body. Changes in these values can provide valuable insights into the patient's hydration status and renal function. Monitoring daily weight is also a reliable way to track fluid retention or loss over time, which can indicate changes in fluid volume status. Option A) Blood pressure and pulse are important vital signs, but they can be influenced by various factors other than fluid volume status, such as pain or anxiety. While changes in serum potassium and sodium levels (Option B) can indicate electrolyte imbalances related to diuretic therapy, they may not directly reflect overall fluid volume status. Option D) Measurements of abdominal girth and calf circumference can be useful in specific situations, such as assessing for peripheral edema, but they may not provide a comprehensive picture of the patient's overall fluid volume status compared to the combination of intake, output, and daily weight monitoring. Educationally, understanding the rationale behind selecting the appropriate assessment measures for fluid volume status in patients on diuretic therapy is vital for nursing practice. It highlights the significance of considering multiple assessment parameters to ensure a holistic approach to patient care and accurate monitoring of treatment outcomes.

Correct Answer: D

Rationale: Spironolactone is a potassium-sparing diuretic that works by blocking the reabsorption of sodium and water in the kidneys while retaining potassium. This mechanism can lead to an increased risk of hyperkalemia, a condition characterized by high levels of potassium in the blood. Therefore, patients taking spironolactone should be closely monitored for signs and symptoms of hyperkalemia, such as muscle weakness, fatigue, and abnormal heart rhythms. In contrast, diuretics like hydrochlorothiazide (choice A), furosemide (choice B), and acetazolamide (choice C) are not typically associated with the risk of hyperkalemia.

Correct Answer: D

Rationale: Heparin is an anticoagulant medication that can lead to excessive bleeding if overdosed. Protamine sulfate is the specific antidote for heparin overdose. It works by binding to heparin and neutralizing its anticoagulant effects. This helps to reverse the effects of heparin and prevent further bleeding complications. In cases of heparin overdose or when rapid reversal of heparin's anticoagulant effects is required, protamine sulfate should be administered. Naloxone is used as an antidote for opioid overdose, Ibutilide is a antiarrhythmic medication used for atrial fibrillation, and Methylphenidate is a stimulant medication used for ADHD.

Correct Answer: C

Rationale: The most helpful test in determining the response to highly active antiretroviral therapy (HAART) in an HIV-positive client is a viral load test. A viral load test measures the amount of HIV in the blood by counting the number of copies of the virus present. Monitoring viral load levels over time provides vital information about how well the antiretroviral medications are working in suppressing the replication of the virus. A decrease in viral load indicates a positive response to the therapy, while an increase may suggest treatment failure or the development of drug resistance. Regular monitoring of viral load is a crucial aspect of managing HIV infection and assessing the effectiveness of antiretroviral therapy.

Correct Answer: D

Rationale: Tremors are a common side effect associated with the use of Phenytoin. Phenytoin is an antiepileptic drug that can affect the nervous system, leading to involuntary shaking or tremors. These tremors can affect different parts of the body and may vary in severity. It is important for individuals taking Phenytoin to be aware of this potential side effect and consult their healthcare provider if they experience tremors as a result of taking the medication.