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    Ati Rn Adult Medical Surgical 2023 Proctored Exam

    A nurse is assessing a client. Which of the following findings indicates a fluid volume deficit?

    Explanation & Rationale

    A. Skin tenting, or decreased skin turgor, occurs when the skin remains elevated after being pinched, indicating dehydration or fluid volume deficit. This is a classic sign of hypovolemia, reflecting a reduction in interstitial and intravascular fluid. Older adults may show this sign more prominently due to loss of skin elasticity with aging. B. Pitting edema indicates fluid volume excess, not deficit. It results from fluid accumulation in the interstitial space, often associated with heart failure, kidney disease, or liver disease. C. Dyspnea can be a sign of fluid overload (e.g., pulmonary edema) rather than fluid volume deficit. Clients with hypovolemia typically experience tachycardia and hypotension, but not usually shortness of breath unless severe hypovolemia affects perfusion. D. Fluid volume deficit generally causes hypotension due to decreased circulating volume. Elevated blood pressure is more commonly associated with hypervolemia.

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