A nurse is collecting data from a client who is in renal failure. The nurse should identify which of the following findings is a manifestation of hyperkalemia.
Dry mucous membranes
Irregular heart rate
Hyperactive reflexes
Trousseau's sign
The Correct Answer is B
A. Incorrect. Dry mucous membranes are not typically associated with hyperkalemia.
B. Correct. Hyperkalemia can lead to cardiac dysrhythmias, including irregular heart rate.
C. Incorrect. Hyperactive reflexes are more commonly associated with hypokalemia (low potassium levels.
D. Incorrect. Trousseau's sign is a clinical indicator of hypocalcemia, not hyperkalemia.
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Related Questions
Correct Answer is C
Explanation
A. Incorrect. Justice refers to fairness and equitable treatment of clients. While important, it does not specifically pertain to the nurse's communication about medication adverse effects.
B. Incorrect. Autonomy refers to the client's right to make decisions about their own care and treatment. While truthfully communicating about medication's adverse effects supports autonomy, veracity is the ethical concept specifically related to truthfulness.
C. Correct. Veracity is the ethical concept of truthfulness and honesty in communication. When the nurse communicates truthfully about the potential adverse effects of the medications, they are demonstrating veracity.
D. Incorrect. Beneficence refers to the duty to do good and promote the well-being of the client.
While important, it is not the ethical concept specifically related to truthful communication about medication's adverse effects.
Correct Answer is D
Explanation
A. The decision to place a loved one in long-term care is complex and should be made based on the family's needs and situation, not dictated by the nurse.
B. Suggesting the son find other family members for help is a reasonable idea, but it does not directly address his fatigue.
C. While taking care of a loved one is important, making the son feel obligated is not supportive or helpful.
D. Correct. Respite care provides temporary relief to caregivers and can help address the son's fatigue while ensuring his mother's needs are met.
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