A nurse is caring for four clients who are at risk for or who have an actual fluid volume deficit. Which client should the nurse assess first? The nurse should first assess the client who
A) is confused and spits out oral foods/fluids.
B) is on a tube-feeding running at 85 ml/hour.
C) was admitted with polyuria.
D) has diarrhea and now is restless.

Question

Quizplus · Accepted Answer

Cellular dehydration can cause neurologic manifestations such as restlessness and apprehension. Neurologic manifestations are always considered serious because coma and even death can result. The nurse should see the client in option d first. Options a and b describe clients who are definitely at risk for dehydration. Option c describes a client who could be at risk for dehydration or who may already be dehydrated, depending on how long the polyuria has been occurring and whether or not the client is already on IV fluids.

A Nurse Is Caring for Four Clients Who Are at Risk