A client’s bloodwork indicates that he has severe hypokalemia.
What is a priority nursing intervention?
Place the client on a cardiac monitor.
Administer a laxative as ordered.
Place the client on seizure precautions.
Restrict high potassium foods.
The Correct Answer is A
This is because hypokalemia (low potassium level in the blood) can cause abnormal heart rhythms (arrhythmia) that can be life-threatening and require urgent medical attention. A cardiac monitor can help detect and treat any arrhythmia that may occur.
Choice B is wrong because administering a laxative can worsen hypokalemia by causing more potassium loss through the digestive tract. Laxative use is one of the possible causes of hypokalemia.
Choice C is wrong because placing the client on seizure precautions is not a priority intervention for hypokalemia. Seizures are not a common symptom of hypokalemia, although muscle weakness and cramps may occur.
Choice D is wrong because restricting high potassium foods is not a priority intervention for hypokalemia. In fact, increasing potassium intake through foods or supplements may be helpful in less serious cases of hypokalemia. However, this should be done according to the doctor’s recommendation and with careful monitoring of blood potassium levels.
Normal blood potassium levels for an adult range from 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life threatening.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The nurse should report the situation to the hospital ethics committee, which is used to resolve ethical dilemmas in the health care setting. The hospital ethics committee can help the nurse and the client’s family reach a consensus on the best course of action for the client.
Choice A is wrong because a clinical education specialist is not directly involved in the client’s care and does not have the authority to intervene in ethical issues.
Choice B is wrong because a quality improvement committee is responsible for monitoring and evaluating the quality of care and services provided by the facility, not for addressing ethical conflicts.
Choice D is wrong because a hospital administrator is not usually involved in the clinical decision-making process and may not have the expertise or time to deal with ethical issues.
Correct Answer is A
Explanation
This demonstrates advocacy for client rights because it respects the client’s autonomy, dignity, and preferences. It also helps the client to make informed decisions about their own health.
Choice B is wrong because telling the client that refusal of the medication is considered noncompliance is coercive and violates the client’s right to refuse treatment.
It also does not address the client’s reasons for refusing the medication or provide any information or education.
Choice C is wrong because informing the client that the medication is the same as taken at home is not enough to ensure that the client understands the purpose, benefits, and risks of the medication.
It also does not verify that the client is taking the medication correctly at home or that there are no changes in the dosage or frequency.
Choice D is wrong because insisting the client takes the prescribed medications is also coercive and violates the client’s right to refuse treatment.
It also does not respect the client’s autonomy, dignity, and preferences.
It may also cause harm to the client if they have an allergy, intolerance, or contraindication to the medication.
Advocacy for nursing stems from a philosophy of nursing in which nursing practice is the support of an individual to promote his or her own well-being, as understood by that individual. It is an ethic of practice that requires nurses to protect and uphold their patients’ rights, values, and interests.
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