Fluid Volume Overload | Fluid and Electrolytes NCLEX & Nursing School Exams Like A Boss

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Fluid Excess – Notes

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FLUID VOLUME OVERLOAD NCLEX QUIZ QUESTIONS

Question 1: The graduate nurse is caring for a patient with heart failure. Upon assessment, the graduate nurse notes dyspnea and crackles when auscultating lung fields. What additional patient presentations would the graduate nurse expect to find in a patient experiencing fluid volume overload?

1. Flat neck veins and decreased urinary output
2. Weight loss and dry skin
3. Weakness and decreased central venous pressure (CVP)
4. An increase in blood pressure and increased respirations

 

Question 2: Which of the following patients are risk for developing fluid volume overload?

1. Patient with an ileostomy from a recent abdominal surgery
2. Patient with kidney disease and a 12-year history of diabetes
3. Patient taking diuretics who has tenting of his or her skin
4. Patient requiring gastrointestinal suctioning

 

Question 3: A patient is admitted for fluid volume overload. Expected findings include:

1. Dyspnea while laying down, leg swelling
2. Confusion, elevated ammonia levels, lethargy
3. Dyspnea upon exertion, leg pain
4. Swelling and redness in extremities

 

Question 4: What order for diagnosis determination do you expect to have on a fluid volume overload patient?

1. Blood cultures, antibiotics, fluid resuscitation
2. 10L nasal cannula
3. Chest x-ray
4. Foley catheter

 

FLUID VOLUME OVERLOAD NCLEX QUIZ ANSWERS

Question 1: The graduate nurse is caring for a patient with heart failure. Upon assessment, the graduate nurse notes dyspnea and crackles when auscultating lung fields. What additional patient presentations would the graduate nurse expect to find in a patient experiencing fluid volume overload?

1. Flat neck veins and decreased urinary output
2. Weight loss and dry skin
3. Weakness and decreased central venous pressure (CVP)
4. An increase in blood pressure and increased respirations

Fluid volume overload occurs when fluid intake or retention exceeds the fluid needs of the body. Assessment findings can include coughing, dyspnea, crackles, tachycardia, tachypnea, elevated blood pressure, elevated CVP, weight gain, edema, bounding pulse, neck vein distension.

 

Question 2: Which of the following patients are risk for developing fluid volume overload?

1. Patient with an ileostomy from a recent abdominal surgery
2. Patient with kidney disease and a 12-year history of diabetes
3. Patient taking diuretics who has tenting of his or her skin
4. Patient requiring gastrointestinal suctioning

Fluid volume overload occurs when fluid intake or retention exceeds the fluid needs of the body. Causes can include decreased kidney function, heart failure, hypotonic fluids, and excessive wound irrigation.

 

Question 3: A patient is admitted for fluid volume overload. Expected findings include:

1. Dyspnea while laying down, leg swelling
2. Confusion, elevated ammonia levels, lethargy
3. Dyspnea upon exertion, leg pain
4. Swelling and redness in extremities

Dyspnea while laying down and swelling are both signs of overload. Fluid can back up into the lungs causing dyspnea. Leg welling occurs when fluid becomes overloaded in the vessels.

 

Question 4: What order for diagnosis determination do you expect to have on a fluid volume overload patient?

1. Blood cultures, antibiotics, fluid resuscitation
2. 10L nasal cannula
3. Chest x-ray
4. Foley catheter

A chest x-ray can help determine if the patient is in fluid volume overload. The chest x-ray will help visualize fluid in the lungs.