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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 ["A","C","D"]

Explanation

Rationale:

A. Preventing vagal stimulation can help prevent bradycardia.

B. Acute pain is not typically associated with sinus bradycardia.

C. Preventing falls is important because bradycardia can lead to dizziness and falls.

D. Assessing for neurologic changes is important because bradycardia can affect cerebral perfusion.

E. Monitoring fluid volume excess is not directly related to sinus bradycardia.

A. Unable to lie flat B. Feeling fatigued C. Distended neck veins D. Increased appetite E. Weight gain 2 in 24hours F. Worsening Lower extremity edema

Correct Answer is ["A","B","C","E","F"]

Explanation

Rationale:

A. Unable to lie flat due to orthopnea is a sign of worsening heart failure.

B. Feeling fatigued is a general symptom of heart failure but can worsen as heart failure progresses.

C. Distended neck veins indicate increased central venous pressure, which is a sign of worsening right-sided heart failure.

D. Increased appetite is not typically associated with worsening heart failure.

E. Weight gain of 2 pounds in 24 hours indicates fluid retention and worsening heart failure.

F. Worsening lower extremity edema is a sign of worsening heart failure.

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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

Naxlex Comprehensive Predictor Exams

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