A nurse is assessing a client who reports numbness and tingling of their toes and exhibits a positive Trousseau's sign. Which of the following electrolyte imbalances should the nurse suspect?
Hyponatremia
Hypocalcemia
Hyperkalemia
Hypermagnesemia
The Correct Answer is B
A. Hyponatremia: While hyponatremia can cause neurological symptoms, such as confusion and seizures, it is not typically associated with a positive Trousseau's sign. Trousseau's sign is more specifically related to calcium imbalances.
B. Hypocalcemia: A positive Trousseau's sign (a spasm of the hand and wrist when a blood pressure cuff is inflated) is a classic sign of hypocalcemia, which is low calcium levels in the blood. Numbness and tingling of the toes (paresthesia) are also common symptoms of hypocalcemia.
C. Hyperkalemia: Hyperkalemia typically causes muscle weakness, fatigue, and potential cardiac arrhythmias, but it does not directly cause a positive Trousseau's sign or numbness and tingling in the extremities.
D. Hypermagnesemia: Hypermagnesemia (high magnesium levels) typically causes symptoms such as muscle weakness, respiratory depression, and hypotension. It is not associated with a positive Trousseau's sign.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administer digoxin by IV bolus: Digoxin slows conduction through the AV node and can worsen a complete heart block. It is contraindicated in this condition and may lead to further bradycardia or cardiac arrest.
B. Prepare the client for temporary pacing:Third-degree (complete) heart block results in electrical dissociation between atria and ventricles, leading to dangerously low heart rates and inadequate perfusion. The definitive treatment is temporary pacing to stabilize the cardiac rhythm until permanent pacing can be arranged.
C. Instruct the client to perform the Valsalva maneuver: This maneuver is used to terminate supraventricular tachycardias by stimulating the vagus nerve. It is not indicated in bradyarrhythmias like third-degree heart block and could further lower the heart rate.
D. Perform carotid sinus massage: This is another vagal maneuver used to treat tachycardias, not bradycardias. Performing it in a client with third-degree heart block could dangerously reduce the heart rate further and is therefore inappropriate.
Correct Answer is C
Explanation
A. Ensure the door to the client's room remains open: The door should be kept closed to minimize exposure to radiation. Keeping the door open increases the risk of radiation exposure to others in the area.
B. Wear sterile gloves during patient care: Sterile gloves are not required for care during internal radiation therapy unless there is direct contact with bodily fluids or radioactive materials. Standard precautions are sufficient.
C. Wear a lead apron when providing client care: A lead apron is recommended for healthcare workers to protect themselves from radiation exposure during internal radiation therapy. The lead apron absorbs radiation and helps reduce the risk of harmful exposure.
D. Place a dosimeter on the client's gown: The dosimeter is typically worn by healthcare workers to measure radiation exposure, not the client. The client would not wear a dosimeter in this situation.
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