A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

A client with a decreased potassium level

A client with a decreased serum glucose

A client with an increased hemoglobin A1C

A client with an increased creatinine level

None

Answer and Explanation

The Correct Answer is B

Choice A Reason:

A client with a decreased potassium level is incorrect. Hypokalemia (decreased potassium level) can cause various neurological symptoms, but it doesn't directly lead to osmotic cerebral edema.

Choice B Reason:

When plasma glucose levels are rapidly lowered, an osmotic gradient develops between the brain and plasma, which can lead to cerebral edema. Brain cells pull water from the plasma, resulting in widespread edema.

Choice C Reason:

While HbA1c is an important marker of diabetes control and may indicate poor long-term management, it does not directly relate to the acute metabolic derangements (e.g., rapid osmotic shifts, severity of acidosis) that predispose to cerebral edema in DKA.

Choice D Reason:

A client with an increased creatinine level is incorrect. Elevated creatinine levels typically indicate kidney dysfunction or dehydration, but they don't directly cause osmotic cerebral edema.

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Correct Answer is A

Explanation

Choice A Reason:

Hypertension is correct. This is a modifiable risk factor for stroke. Hypertension, or high blood pressure, significantly increases the risk of stroke. Treating and controlling hypertension through lifestyle changes and medication can help reduce the risk of stroke.

Choice B Reason:

Client's age is incorrect. While age itself is not modifiable, age is a non-modifiable risk factor for stroke. Risk of stroke increases with age, particularly in individuals over 55 years old. However, other modifiable risk factors can be addressed to reduce overall risk.

Choice C Reason:

History of sickle cell disease is incorrect. Sickle cell disease is a genetic disorder characterized by abnormal hemoglobin in red blood cells. While sickle cell disease increases the risk of certain complications, such as stroke in children, it is not a modifiable risk factor in the traditional sense.

Choice D Reason:

Parent who has cardiovascular disease is incorrect. While having a parent with cardiovascular disease may indicate a genetic predisposition to certain risk factors, it is not a direct modifiable risk factor for stroke. However, individuals with a family history of cardiovascular disease may have increased awareness and motivation to address modifiable risk factors such as hypertension, smoking, and diabetes.

A. Flying B. Sunbathing C. Working in an office D. High altitude travel

Correct Answer is B

Explanation

Choice A Reason:

Flying itself is not typically considered a factor that worsens MS manifestations. However, factors related to flying, such as stress, fatigue, changes in routine, and potential exposure to infections, may contribute to symptom exacerbation in some individuals with MS.

Choice B Reason:

Sunbathing is appropriate. Exposure to excessive heat, such as sunbathing or prolonged exposure to hot weather, can lead to temporary worsening of MS symptoms, a phenomenon known as Uhthoff's phenomenon. Increased body temperature can temporarily impair nerve conduction in individuals with MS, resulting in exacerbation of symptoms such as fatigue, weakness, sensory disturbances, and cognitive impairment.

Choice C Reason:

Working in an office is inappropriate. Working in an office environment is not inherently associated with exacerbation of MS manifestations. However, factors such as stress, fatigue, poor ergonomic conditions, and limited mobility during prolonged periods of sitting may contribute to symptom exacerbation in some individuals with MS.

Choice D Reason:

High altitude travel is inappropriate. High altitude travel can exacerbate MS symptoms due to the decreased oxygen levels and potential changes in barometric pressure at high altitudes. Hypoxia (low oxygen levels) at high altitudes may exacerbate fatigue, weakness, and cognitive impairment in individuals with MS. Changes in barometric pressure can also trigger or worsen symptoms such as headaches, sensory disturbances, and balance problems in some individuals with MS.

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A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

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