A nurse is caring for a client with hypernatremia. Which of the following actions should the nurse take?

• Choice A reason:

• Administering calcium supplements orally or IV is not an appropriate intervention for a client with hypocalcemia. Calcium supplements can cause hypercalcemia, which can lead to cardiac arrhythmias, kidney stones, and constipation. Calcium supplements should only be given if the hypocalcemia is severe or symptomatic and under the supervision of a physician.

• Choice B reason:

• Monitoring the client for signs of tetany and seizures is an appropriate intervention for a client with hypocalcemia. Hypocalcemia can cause increased neuromuscular excitability, which can manifest as muscle spasms, cramps, twitching, or convulsions. Tetany is a condition where the muscles contract involuntarily and can affect the hands, feet, face, or larynx. Seizures are a result of abnormal electrical activity in the brain that can be triggered by low calcium levels. The nurse should monitor the client for these signs and intervene promptly to prevent complications.

• Choice C reason:

• Providing a high-phosphorus diet is not an appropriate intervention for a client with hypocalcemia. Phosphorus and calcium have an inverse relationship in the body, meaning that when one is high, the other is low. A high-phosphorus diet can lower the serum calcium level further and worsen the hypocalcemia. The nurse should advise the client to avoid foods high in phosphorus, such as dairy products, meat, poultry, fish, eggs, nuts, seeds, beans, and cola drinks.

• Choice D reason:

• Avoiding stimulating the facial nerve is not an appropriate intervention for a client with hypocalcemia. Stimulating the facial nerve can elicit a positive Chvostek's sign, which is a facial twitching that occurs when the nerve is tapped near the ear. A positive Chvostek's sign indicates hypocalcemia and increased neuromuscular irritability. However, avoiding stimulating the facial nerve does not prevent or treat hypocalcemia. The nurse should monitor the client for other signs of hypocalcemia and administer calcium as prescribed.

Choice A reason:

Serum sodium level less than 135 mEq/L. This is an expected finding of hyponatremia, which is a condition of low sodium concentration in the blood. Sodium is an electrolyte that helps regulate fluid balance, nerve impulses, and muscle contractions. Hyponatremia can result from excessive fluid intake, diuretic use, vomiting, diarrhea, or kidney disease.

Choice B reason:

Serum osmolality less than 280 mOsm/kg. This is an expected finding of hyponatremia, which is a measure of the concentration of solutes in the blood. Osmolality reflects the body's ability to maintain fluid balance and hydration status. Hyponatremia causes a decrease in osmolality due to dilution of the blood by excess water.

Choice C reason:

Urine specific gravity less than 1.010. This is an expected finding of hyponatremia, which is a measure of the concentration of solutes in the urine. Specific gravity reflects the kidney's ability to concentrate or dilute urine. Hyponatremia causes a decrease in specific gravity due to increased urine output and water excretion.

Choice D reason:

Urine sodium level greater than 20 mEq/L. This is an expected finding of hyponatremia, which is a measure of the amount of sodium excreted in the urine. Sodium excretion reflects the kidney's ability to regulate sodium balance and fluid volume. Hyponatremia causes an increase in urine sodium level due to impaired sodium reabsorption and increased sodium loss.

Choice E reason:

Serum potassium level greater than 5 mEq/L. This is not an expected finding of hyponatremia, but rather a finding of hyperkalemia, which is a condition of high potassium concentration in the blood. Potassium is an electrolyte that helps regulate cardiac and neuromuscular function. Hyperkalemia can result from renal failure, acidosis, tissue injury, or medications that affect potassium excretion or shift.