A nurse is collecting data from a client who has a sodium level of 128 mEq/L. Which of the following manifestations should the nurse expect?
Hyporeflexia.
Constipation.
Increased appetite.
Headache.
The Correct Answer is D
The correct answer is Choice D: Headache.
Rationale for Choice D (Headache): Hyponatremia, defined as a serum sodium level below 135 mEq/L, can lead to various neurological symptoms due to the altered osmotic pressure in the brain cells. When the sodium level drops below normal, water moves into the cells, causing them to swell, which can lead to increased intracranial pressure and subsequent headaches. Therefore, a client with a sodium level of 128 mEq/L is likely to experience headaches as a manifestation of hyponatremia.
Rationale for other choices:
Choice A: Hyporeflexia Hyporeflexia refers to diminished or absent reflexes. While hyponatremia can affect neurological function, hyporeflexia is not a typical manifestation. Instead, hyperreflexia may occur in severe cases due to cerebral edema and increased intracranial pressure.
Choice B: Constipation Constipation is not a common manifestation of hyponatremia. Gastrointestinal symptoms such as nausea, vomiting, and abdominal cramping may occur, but constipation is not typically associated with sodium imbalances.
Choice C: Increased appetite Hyponatremia does not typically cause increased appetite. Instead, gastrointestinal symptoms such as nausea and anorexia are more commonly observed. Increased appetite is not directly related to sodium levels but may be seen in conditions such as hyperthyroidism or certain medications.
Therefore, based on the provided data and typical manifestations of hyponatremia, the correct answer is Choice D: Headache. This is because headaches are a common neurological symptom associated with low sodium levels and increased intracranial pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
The nurse should not instruct the client to rest with the legs above heart level. While elevating the legs can be helpful for managing symptoms of peripheral artery disease (PAD), it is not a suitable choice for older adults, especially those with heart conditions. It can put additional strain on the heart and may not be appropriate for all clients. Elevation of the legs should be done with caution and under healthcare provider guidance.
Choice B rationale:
The nurse should not advise the client to wear antiembolic stockings during the day. Antiembolic stockings, also known as compression stockings, are primarily used for venous insufficiency and the prevention of deep vein thrombosis (DVT). They may not be effective or necessary for the management of PAD. It's important to tailor the instructions to the specific condition, and in the case of PAD, other strategies may be more appropriate.
Choice C rationale:
The correct answer is choice C. The nurse should instruct the client to adjust the thermostat so that the environment is warm. This is an important recommendation for clients with PAD because keeping the extremities warm can help improve circulation and reduce symptoms. Cold environments can exacerbate the vasoconstriction associated with PAD, leading to more discomfort. Maintaining a warm environment is a simple and effective measure for symptom management.
Choice D rationale:
The nurse should not recommend applying a heating pad on a low setting to help relieve leg pain. While heat can provide temporary relief for muscle pain, it may not be the best option for clients with PAD. Applying heat directly to the affected area can sometimes lead to burns or skin damage, especially in older adults who may have decreased sensation. Heat should be used cautiously, and other methods like keeping the environment warm are preferred.
Correct Answer is C
Explanation
The correct answer is: C.
Choice A reason: A pH of 7.50 and HCO3 of 31 mm Hg suggest a metabolic alkalosis due to the high bicarbonate level. However, during a panic attack, hyperventilation leads to respiratory alkalosis, not metabolic, due to the excessive exhalation of CO2, which is not consistent with this option.
Choice B reason: A pH of 7.30 and HCO3 of 19 mm Hg indicate a metabolic acidosis due to the low bicarbonate level. This is not typically associated with hyperventilation during a panic attack, which usually causes respiratory alkalosis, characterized by a decrease in CO2 levels and an increase in pH.
Choice C reason: A pH of 7.47 and PaCO2 of 31 mm Hg are indicative of respiratory alkalosis, which is expected during hyperventilation as a result of a panic attack. Hyperventilation causes a decrease in carbon dioxide (PaCO2) levels, leading to an increase in pH. The normal ranges for arterial blood gases are: pH 7.35-7.45, PaCO2 35-45 mm Hg, and HCO3 22-26 mEq/L.
Choice D reason: A pH of 7.32 and PaCO2 of 50 mm Hg suggest respiratory acidosis due to the elevated PaCO2 level. This would be more consistent with hypoventilation, which is not the case during a panic attack where hyperventilation occurs.
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