NCLEX-RN (Registered Nurse) Practice Exam · Question
A 78-year-old client with a history of heart failure is admitted with shortness of breath, bilateral pitting edema, and a 5 kg weight gain over 3 days. The nurse observes JVD and crackles in both lung bases. Which prescription should the nurse question?
Increasing intravenous fluid intake in a client with signs and symptoms of fluid volume overload, such as those seen in heart failure, would exacerbate their co
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Question: A 78-year-old client with a history of heart failure is admitted with shortness of breath, bilateral pitting edema, and a 5 kg weight gain over 3 days. The nurse observes JVD and crackles in both lung bases. Which prescription should the nurse question?
Answer options:
- Administer furosemide 40 mg PO daily.
- Provide a 2-gram sodium diet. ✅ Increase intravenous fluid intake to 150 mL/hr.
- Monitor strict intake and output.
Correct answer: Increase intravenous fluid intake to 150 mL/hr.
Explanation: Increasing intravenous fluid intake in a client with signs and symptoms of fluid volume overload, such as those seen in heart failure, would exacerbate their condition and is contraindicated. The nurse should question this prescription immediately.
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