NORCET 5 Prelims - Sept 2023 (Shift-1)
Medical & Surgical Nursing
Medium
A patient who is receiving vasopressin. Which of the following is a best assessment for fluid status?
Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)
Explanation
- Vasopressin is an antidiuretic hormone (ADH) that promotes water reabsorption by the kidneys, increasing the risk of fluid volume excess.
- Daily weight is the most sensitive and accurate indicator of a patient's fluid status.
- A weight gain of 1 kg (2.2 lbs) overnight is equivalent to retaining 1 liter of fluid.
- Monitoring daily weight allows for the early detection of fluid retention before more severe symptoms like pulmonary edema or hyponatremia develop.
Why Other Options Were Wrong
- Option B: Monitoring for constipation is not a primary or sensitive assessment for fluid volume status. It is more commonly associated with electrolyte imbalances like hypokalemia or hypercalcemia, or decreased gut motility.
- Option C: Testing for glycosuria (glucose in the urine) is an assessment for hyperglycemia, not fluid balance. It has no direct relationship to the effects of vasopressin.
- Option D: This is a therapeutic intervention, not an assessment. The question asks for the best way to assess the patient's condition, not how to manage it.
Related Visual
- Visual 1: Diagram: Action of ADH (Vasopressin) on the kidney's collecting ducts, showing how it increases water reabsorption.
- Visual 2: Infographic: A scale showing '1 kg weight gain = 1 L fluid retained' to visually reinforce the core concept.
- Visual 3: Chart: Comparing different methods of fluid status assessment (Daily Weight, I&O, Skin Turgor, Mucous Membranes) and their reliability.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Fluid balance assessment during vasopressin therapy to guide bedside assessment, documentation, and the next nursing action.
- A nurse's primary responsibility for a patient on vasopressin is to monitor for signs of water intoxication and fluid overload, which can be life-threatening.
- Accurate daily weights (same time, same scale, same clothing) are a critical nursing skill that directly impacts patient safety in this context.
- What if? If the patient developed a headache, confusion, and a low serum sodium level, the nurse should suspect water intoxication (a complication of vasopressin), notify the healthcare provider immediately, and anticipate orders to restrict fluids and possibly administer a hypertonic saline solution.
How to Approach the Question
- First, identify the keyword in the question: 'vasopressin'. Recall its function as an antidiuretic hormone (ADH), which means it makes the body hold onto water.
- Next, understand the core of the question: it asks for the 'best assessment' of 'fluid status'. This requires you to evaluate different monitoring techniques.
- Differentiate between 'assessment' (gathering data) and 'intervention' (taking action). This immediately helps to eliminate 'Restrict fluid intake', which is an intervention.
- Evaluate the remaining assessment options. 'Daily weight' is a direct measure of total body fluid. 'Monitor for constipation' and 'Test for Glycosuria' are indirect or irrelevant to the primary effect of vasopressin.
- Conclude that daily weight is the most direct, sensitive, and accurate method to assess for fluid retention caused by vasopressin.
Concept Tested & Keywords
- Concept Tested: Fluid balance assessment during vasopressin therapy.
- Stem keywords: vasopressin, assessment, fluid status
- Lead-in keywords: best
- Clinical cues: patient receiving vasopressin
Question ID
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Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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