ATI RN
ATI Pediatric Nursing n100 Exam Questions
Extract:
A 66-year-old client who reports having a fever and feeling weak and dizzy with nausea and vomiting for three days.
Question 1 of 5
The nurse is assessing a 66-year-old client who reports having a fever and feeling weak and dizzy with nausea and vomiting for three days. The nurse observes a dry tongue and oral mucosa, and concentrated urine. To best assess the client's fluid status, which parameter(s) should the nurse check?
Correct Answer: B
Rationale: The correct answer is B: BP and pulse in lying, then sitting and standing positions.
Step 1: Assessing the client's BP and pulse in different positions helps determine orthostatic hypotension, indicating fluid volume deficit.
Step 2: Orthostatic hypotension is a common sign of dehydration due to decreased blood volume.
Step 3: Monitoring these parameters will provide information on the client's fluid status and guide appropriate interventions.
Summary:
A: Temperature alone does not provide a comprehensive assessment of fluid status.
C: Pulse oximetry is used to assess oxygenation, not fluid status.
D: While respiratory rate and depth are important, they do not directly assess fluid status.
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