NCLEX Question.

[andrewprincesspeach]

Which of these clients should the nurse see first for possibly life threatening fluid volume deficit.

1. 88yr old with a fractured femur scheduled for surgery.

2. 65 yr old recently diagnosed with congestive heart failure.

3. 50 yr old with second degree burns on angles and feet.

4. 20 yr old with 5 year history of type 1 diabetes mellitus.

[student_nurse24]

Don't listen to these folks talking about the burn. 2nd degree burns form blisters almost right away. Fluid is trapped in those blisters but the burn to the ankles & feet isn't going to cause a LIFE THREATENING fluid deficit. (key in the questions, LIFE THREATENING) (All the choices may cause a fluid deficit)

A femur fracture will cause a life threatening fluid deficit, if the femoral artery is broken then you can bleed to death in minutes. If the fracture is not open you won't even notice the bleeding it will be internal. Both scenarios are LIFE THREATENING. Get an H&H STAT! lol

I'd bet $50 on my answer and rationale being right.

[student_nurse24]

5. Don't come here asking us to do your hw for you.

Don't give people the wrong answer and be smug about it. This is a place people can ask for help.

[nicoleRN831]

in #1 the patient is also scheduled for surgery so they are going to be NPO, so add that on top of the possible blood loss for the fractured femur and that's the greatest risk for fluid volume deficit

[NurseAdida]

Don't read too much into the question, nobody said the femoral artery was affected in any way. So my answer is 3. Patients with burns take priority in fluid rescucitation. This patient has risk for fluid deficit.

Whoever said the fluid is trapped in blisters so doesn't count as loss...well the fluid trapped in blisters does not benefit the body in any way. Its trapped.

Could you please tell us the answer...

[NurseAdida]

in #1 the patient is also scheduled for surgery so they are going to be NPO, so add that on top of the possible blood loss for the fractured femur and that's the greatest risk for fluid volume deficit

The question is about pre-surgical period. Post surgical period this patient would be at risk but this is before surgery. Before surgery patients are NPO after midnight, that shouldn't significantly cause fluid deficit.

[LA_StudentNurse]

Which of these clients should the nurse see first for possibly life threatening fluid volume deficit.

1. 88yr old with a fractured femur scheduled for surgery.- trauma and age = risk for FVD

2. 65 yr old recently diagnosed with congestive heart failure. --not FVD; CHF would have FVE

3. 50 yr old with second degree burns on ankles and feet. --2nd degree burns; it may be possible FVD because of loss of tissue and fluids, etc

4. 20 yr old with 5 year history of type 1 diabetes mellitus--5 year hx. This is chronic not newly dx. I would imagine the problem is ketoacidosis resulting in dehydration. Potential FVD.

My vote is the 88 yo pt with fx femur.

Rationale: fx, trauma, possible loss of blood and fluid loss from edema/swelling, age impaires water conservation, a dependency on others for hydration, delayed and less intense thirst response than younger persons, and a decrease in urine concentration with aging. All of which stresses an aging body that already has difficulty maintaining homeostasis related to lower total body water stores and an aging system that is slow to respond to fluid loss.

The elderly pt is already at risk and throw in an acute illness or injury and you have a patient at serious risk for FVD .