A nurse is caring for a patient whose sodium level is 118 mEq/L. Which nursing diagnosis is a priority for this patient?

Choice A: Contraction of the facial muscle is correct because it indicates a positive Chvostek's sign, which is a sign of hypocalcemia, or low calcium level in the blood. Chvostek's sign is elicited by tapping the facial nerve in front of the ear and observing for twitching of the facial muscles on the same side.

Choice B: Asked when the foot numbness would go away is incorrect because it is not a specific sign of hypocalcemia, although it can indicate peripheral neuropathy, which can be caused by various conditions such as diabetes, vitamin B12 deficiency, or alcohol abuse.

Choice C: Carpal spasm with blood pressure measurement is correct because it indicates a positive Trousseau's sign, which is another sign of hypocalcemia. Trousseau's sign is elicited by inflating a blood pressure cuff on the upper arm and observing for flexion of the wrist and fingers.

Choice D: Complaints of fingers tingling is correct because it indicates paresthesia, which is a sensation of numbness, tingling, or prickling in the extremities. Paresthesia can be caused by hypocalcemia, as low calcium level can affect the nerve conduction and excitability.

Choice E: Heart rate 88 and regular is incorrect because it is within the normal range of heart rate, which is 60 to 100 beats per minute. Heart rate can be affected by hypocalcemia, but usually in the opposite direction, causing bradycardia, or slow heart rate, or cardiac arrhythmias, or irregular heartbeats.

Choice A Reason: This is correct because BUN stands for blood urea nitrogen, which is a waste product of protein metabolism that is excreted by the kidneys. Increased BUN indicates fluid volume deficit, as the blood becomes more concentrated and the kidneys have less fluid to filter. A normal BUN level is 7 to 20 mg/dL. The nurse should monitor the client's fluid intake and output, weight, and serum electrolytes, and administer fluids as ordered.

Choice B Reason: This is incorrect because urine ketones are not related to fluid volume deficit, but to diabetic ketoacidosis, which is a complication of diabetes mellitus that occurs when the body breaks down fat for energy and produces ketones as a by-product. Increased urine ketones indicate diabetic ketoacidosis, which can cause

dehydration, acidosis, and coma. A normal urine ketone level is negative or trace. The nurse should monitor the client's blood glucose, pH, and bicarbonate levels, and administer insulin and fluids as ordered.

Choice C Reason: This is incorrect because urine specific gravity is a measure of the concentration of solutes in the urine. Decreased urine specific gravity indicates fluid volume excess, as the urine becomes more diluted and the kidneys excrete more fluid. A normal urine specific gravity range is 1.005 to 1.030. The nurse should monitor the client's fluid balance, vital signs, and edema, and administer diuretics as ordered.

Choice D Reason: This is incorrect because Hgb stands for hemoglobin, which is a protein in red blood cells that carries oxygen. Decreased Hgb indicates anemia, which is a condition that occurs when the blood has a low number of red blood cells or hemoglobin. Anemia can cause fatigue, weakness, and pallor. A normal Hgb level for adult males is 14 to 18 g/dL and for adult females is 12 to 16 g/dL. The nurse should monitor the client's oxygen saturation, iron level, and blood transfusion needs, and administer iron supplements or erythropoietin as ordered.