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A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Suggest that the client use a salt substitute.

Advise the client to add citrus juices and bananas to her diet.

Obtain a 12-lead ECG

Obtain a blood sample for a serum sodium level

Answer and Explanation

The Correct Answer is C

Rationale:

A. Salt substitutes often contain potassium and should be avoided in clients with hyperkalemia.

B. Citrus juices and bananas are high in potassium and should be avoided in clients with hyperkalemia.

C. A 12-lead ECG may include changes such as peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration.

D. A serum sodium level should be obtained but it is not the priority in this case.

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Correct Answer is B

Explanation

Rationale:

A. Anorexia is a common symptom of infective endocarditis but is not typically the priority assessment finding.

B. Fever is a hallmark sign of infective endocarditis and should be monitored closely.

C. Dyspnea is a common symptom of infective endocarditis but is not typically the priority assessment finding.

D. Malaise is a common symptom of infective endocarditis but is not typically the priority assessment finding.

A. Petechiae B. Slowing pulse rate C. Confusion D. Pruritus

Correct Answer is A

Explanation

Rationale:

A. Petechiae are small, pinpoint red or purple spots on the skin that may indicate bleeding or thrombocytopenia, which can be a side effect of heparin therapy.

B. Slowing pulse rate is not typically associated with heparin therapy.

C. Confusion is not typically associated with heparin therapy.

D. Pruritus (itching) is not typically associated with heparin therapy.

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A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Nursing Test Bank

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