A nurse is collecting data from a client who has hypokalemia as a result of nausea, vomiting, and diarrhea.
Which of the following findings should the nurse expect?

Extreme thirst.

Weak, irregular pulse.

Hyperactive bowel sounds.

Hyperactive reflexes.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Extreme thirst is not a typical finding in a client with hypokalemia. Hypokalemia is an electrolyte imbalance that can lead to symptoms like weakness and irregular heartbeats, but extreme thirst is not a direct result of low potassium levels.

Choice B rationale:

"Weak, irregular pulse" is the correct response. Hypokalemia can lead to cardiac arrhythmias, which may manifest as a weak, irregular pulse. Potassium plays a crucial role in maintaining the electrical activity of the heart, and low levels can disrupt normal heart rhythms.

Choice C rationale:

Hyperactive bowel sounds are not typically associated with hypokalemia. Instead, you might expect diminished or absent bowel sounds in severe cases due to muscle weakness.

Choice D rationale:

Hyperactive reflexes are not typically associated with hypokalemia. Instead, hypokalemia can lead to muscle weakness and potentially even paralysis in severe cases.

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Correct Answer is A

Explanation

Choice A rationale:

Withholding the digoxin dose for a decreased heart rate is the correct action. Digoxin is a medication used to treat heart failure, but it can lead to bradycardia (slow heart rate) as a side effect. In this scenario, the client's heart rate is already at 54 beats per minute, which is below the normal range. Administering digoxin could further slow the heart rate, potentially leading to dangerous bradycardia or heart block. Withholding the medication is essential to prevent this adverse event.

Choice B rationale:

Administering digoxin 0.25 mg is not the appropriate action in this case. The client's heart rate is already below the normal range, and giving the full dose of digoxin could further depress the heart rate and increase the risk of bradycardia. Withholding the medication is the safer course of action.

Choice C rationale:

Administering digoxin 0.125 mg is not recommended because the client's heart rate is already below the normal range. While a reduced dose may be considered in some situations, it's essential to withhold the medication and consult with the healthcare provider in this specific case, as the client's heart rate is significantly low.

Choice D rationale:

Withholding the digoxin dose for elevated BP is not the appropriate action. Digoxin is primarily used to treat heart failure by increasing the force of cardiac contractions. Elevated blood pressure is not an indication to withhold digoxin. The focus should be on addressing the low heart rate in this scenario. .

A. Provide samples for sputum cultures every 6 weeks. B. Consume alcohol in moderation while taking antituberculosis medications. C. Wear a mask while out or around crowds of people. D. Place tissue soiled with respiratory secretions in a paper bag for later disposal.

Correct Answer is C

Explanation

Choice A rationale:

Providing samples for sputum cultures every 6 weeks is not a necessary instruction for a client with pulmonary tuberculosis. Sputum cultures are typically performed at specific intervals to monitor the progress of treatment and assess for bacterial resistance. This information is essential for healthcare providers but not for the client's daily care and safety.

Choice B rationale:

Consuming alcohol in moderation while taking antituberculosis medications is not recommended. Alcohol can interact with these medications and reduce their effectiveness. It is essential to advise the client to avoid alcohol completely while on tuberculosis treatment to ensure the best possible outcome.

Choice C rationale:

Wearing a mask while out or around crowds of people is a crucial precaution to prevent the spread of tuberculosis, which is highly contagious. Tuberculosis is transmitted through the air when an infected person coughs or sneezes, making mask-wearing an effective measure to protect both the client and others. This instruction promotes the safety of the client and the community.

Choice D rationale:

Placing tissue soiled with respiratory secretions in a paper bag for later disposal is not a recommended practice. Infectious material should be properly disposed of in biohazard containers or bags designed for infectious waste. This instruction does not follow the standard safety protocols for managing infectious materials and is not in the best interest of the client's health.

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A nurse is collecting data from a client who has hypokalemia as a result of nausea, vomiting, and diarrhea.Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a prescription for digoxin 0.25 mg P.O. daily for heart failure.The client's current vital signs are: BP 144/96, heart rate 54/min, respirations 18/min, and temperature 37°C (98.6°F). Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is preparing to review discharge instructions with a client who has pulmonary tuberculosis.Which of the following information should the nurse include?

Correct Answer is C

Explanation

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A nurse is collecting data from a client who has hypokalemia as a result of nausea, vomiting, and diarrhea.
Which of the following findings should the nurse expect?