The nurse in the emergency department is assessing a client with ...

[tnt_battle]

The nurse in the emergency department is assessing a client with bulimia nervosa. Which assessment findings indicate that the client is dehydrated?
 
  Select all that apply.
  A) Dry mouth
  B) Hypertension
  C) Concentrated urine
  D) General weakness
  E) Poor skin turgor

Question 2

The nurse is admitting a client to the medical unit who was brought to the emergency department by a neighbor. The client states, I ran out of my medication last week. I don't have any family or close friends to help me.
 
  Upon assessment, the nurse notes the following findings: oxygen saturation of 93 on room air, breath sounds reveal crackles bilateral bases, P 110 bpm, R 22 breaths per min, BP 110/60 mmHg. Which is the priority psychosocial nursing diagnosis for this client?
  A) Social Isolation
  B) Impaired Gas Exchange
  C) Noncompliance
  D) Interrupted Family Process

[mcarey591]

Answer to Question 1

Answer: A, C, D, E

Hypertension would not be a sign that the client is dehydrated. A client who is dehydrated may exhibit hypotension, dry mouth, poor skin turgor, lightheadedness or dizziness, general weakness, decreased urine production, and concentrated urine.

Answer to Question 2

Answer: A

Social isolation lead to the client's current medical manifestations. The priority nursing diagnosis based on the data is Social Isolation. While Risk for Impaired Gas Exchange would also be appropriate for this client, the current data does not suggestion Impaired Gas Exchange. Noncompliance and Interrupted Family Processes are not supported by the scenario presented.