70.The home health nurse visits an elderly client who lives at home
with her husband. The client is experiencing frequent episodes of
diarrhea and bowel incontinence. Which problem, for which the client
is at risk, has the greatest priority when planning the client's care?
A. Disturbed sleep pattern.
B. Caregiver role strain.
C. Impaired skin integrity.
D. Fluid volume imbalance.
Diarrhea can lead to fluid volume loss, which is potentially life-
threatening, so the highest priority is to prevent a fluid volume
imbalance (D). Diarrhea and bowel incontinence can also lead to (A,
B, and C), but these are of less potential harm than a fluid volume
deficit.
Correct Answer: D
with her husband. The client is experiencing frequent episodes of
diarrhea and bowel incontinence. Which problem, for which the client
is at risk, has the greatest priority when planning the client's care?
A. Disturbed sleep pattern.
B. Caregiver role strain.
C. Impaired skin integrity.
D. Fluid volume imbalance.
Diarrhea can lead to fluid volume loss, which is potentially life-
threatening, so the highest priority is to prevent a fluid volume
imbalance (D). Diarrhea and bowel incontinence can also lead to (A,
B, and C), but these are of less potential harm than a fluid volume
deficit.
Correct Answer: D
