Practice Quiz

MSNCB Medical-Surgical Nursing Exam Prep

Category - Medical Surgical

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The nurse is developing a plan for Mrs. Ramos, a 38-year-old housewife, who is going home with a new diagnosis of heart failure. The nurse is teaching Mrs. Ramos to monitor fluid status. Which of the following is the best instruction?
  1. Restrict fluid intake to 800ml per day
  2. Increase the dose of diuretics if there is decreased urination
  3. Record body weight every day before breakfast and report a weight gain of 3 or more pounds in a week
  4. Keep track of daily output and call the doctor for if it is less than 1 liter on any day
Explanation
Answer - C - Daily weight is the most sensitive indicator of changes in fluid status. It is more accurate for a client at home than urine output. Fluid restriction may be recommended for a client with advanced heart failure, but it is not a method of monitoring fluid status. The client should never adjust the dose of his or her medications.
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