NCLEX-PN

Category - Pharmacological Therapies

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A nurse is caring for a client who is on 5% dextrose in water due to dehydration. The nurse expects the physician to order additional IV fluids if the client is observed with the following signs during assessment except:

Skin and mouth dryness
Thready pulse
Light yellow urine
Flat neck veins in dependent positions

Explanation

Answer: C - A light yellow urine indicates that the client is receiving sufficient amounts of fluid. Skin and mouth dryness, flat neck veins in dependent positions, and a thready pulse are signs of fluid volume deficit, which require additional IV fluids.

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