A nurse is assessing a client who has fluid volume deficit. Which of the following findings should the nurse expect?
A.
Increased skin turgor.
B.
Hypertension.
C.
Tachycardia.
D.
Crackles in the lungs.
The Correct Answer and Explanation is:
The correct answer is C. Tachycardia.
Explanation:
Fluid volume deficit, also known as hypovolemia, occurs when the body loses more fluid than it takes in, leading to a decrease in circulating blood volume. This condition can be caused by various factors such as excessive vomiting, diarrhea, bleeding, or dehydration. The body responds to this deficit through several physiological mechanisms aimed at compensating for the reduced blood volume.
- Tachycardia (C): One of the primary compensatory mechanisms the body employs in response to fluid volume deficit is an increased heart rate, or tachycardia. When blood volume decreases, the heart pumps faster to maintain adequate blood pressure and perfusion to vital organs. Tachycardia helps to compensate for the reduced volume of blood available to circulate throughout the body. It is a classic sign observed in clients with fluid volume deficit.
- Increased Skin Turgor (A): Increased skin turgor is generally not associated with fluid volume deficit. In fact, one of the signs of fluid volume deficit is decreased skin turgor, which means the skin loses its elasticity and may appear tented when pinched. This occurs because the skin loses fluid and becomes less resilient.
- Hypertension (B): Fluid volume deficit typically results in hypotension, not hypertension. As blood volume decreases, the blood pressure drops because there is less fluid exerting pressure against the walls of the blood vessels. Hypotension is a common finding in clients with fluid volume deficit.
- Crackles in the Lungs (D): Crackles, or rales, in the lungs are generally associated with fluid volume excess, not deficit. They indicate fluid accumulation in the alveoli, often seen in conditions like heart failure or pulmonary edema. In fluid volume deficit, the lungs are usually clear unless there is another underlying condition causing fluid accumulation.
In summary, when assessing a client with fluid volume deficit, the nurse should expect findings such as tachycardia, decreased skin turgor, and hypotension, rather than increased skin turgor, hypertension, or crackles in the lungs.