A nurse is caring for a client who has respiratory alkalosis and is hyperventilating Which of the following actions should the nurse take?

Have the client place their head between their knees.

Have the client breath into a paper bag.

Plan to administer sodium bicarbonate to the client

Plan to administer insulin to the client

Answer and Explanation

The Correct Answer is B

A.   Having the client place their head between their knees is a measure used to alleviate symptoms associated with hyperventilation but does not directly address the underlying respiratory alkalosis.
B.   Having the client breathe into a paper bag helps retain carbon dioxide, which can help reverse respiratory alkalosis by increasing PaCO2 levels and subsequently decreasing pH.
C.   Administering sodium bicarbonate would worsen alkalosis by further increasing the pH and bicarbonate levels.
D.   Administering insulin is not indicated for respiratory alkalosis and hyperventilation.

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Correct Answer is B

Explanation

A. Administering corticosteroids is crucial during an Addisonian crisis but typically involves intravenous corticosteroids (not oral) during the crisis to quickly restore hormone levels. Oral corticosteroids are part of regular maintenance therapy but not an immediate intervention in the crisis.

B. Weighing the client daily is important to monitor for potential fluid loss, dehydration, or weight changes related to Addison's disease and Addisonian crisis. Clients with Addison’s disease may experience fluid and electrolyte imbalances, so daily weight tracking helps detect early signs of fluid shifts, which are critical in crisis prevention and management.

C. A low-carbohydrate diet is not recommended for clients with Addison’s disease, as they may need a balanced diet with sufficient carbohydrates to prevent hypoglycemia.

D. Fluid intake should not be restricted; rather, maintaining adequate hydration is vital. Clients in Addisonian crisis are often at risk for dehydration due to fluid losses and low aldosterone levels, making fluid replacement essential.

A. Wheezing B. Decreased deep tendon reflexes C. Cerebral edema D. Hypoactive bowel sounds

Correct Answer is B

Explanation

A. Wheezing is not typically associated with hyperkalemia. It can be seen in conditions such as asthma or chronic obstructive pulmonary disease (COPD).
B. Hyperkalemia can lead to neuromuscular manifestations, including decreased deep tendon reflexes due to suppression of neuromuscular excitability.
C. Cerebral edema is not a typical manifestation of hyperkalemia. It may occur in conditions such as hyponatremia or severe metabolic acidosis.
D. Gastrointestinal manifestations of hyperkalemia are typically related to smooth muscle involvement and can include hyperactive bowel sounds or diarrhea.

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A nurse is caring for a client who has respiratory alkalosis and is hyperventilating Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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