A nurse is contributing to the plan of care for a client who has a potassium level of 2.9 mEq/L. Which of the following actions should the nurse plan?

Give a dose of alendronate.

Administer furosemide.

Apply a cardiac monitor.

Monitor for Chvostek's sign.

Answer and Explanation

The Correct Answer is C

A. Give a dose of alendronate is incorrect. Alendronate is a medication used to treat osteoporosis, and it does not address low potassium levels. In this case, the focus should be on correcting the potassium imbalance.

B. Administer furosemide is incorrect. Furosemide is a diuretic that can cause further loss of potassium. In a client with low potassium levels (hypokalemia., administering furosemide could worsen the condition and lead to life-threatening complications.

C. Apply a cardiac monitor is correct. Hypokalemia (potassium level of 2.9 mEq/L) can cause significant cardiac arrhythmias, including ventricular tachycardia or fibrillation. Applying a cardiac monitor is essential for monitoring the client’s heart rhythm and detecting any abnormalities related to the low potassium level.

D. Monitor for Chvostek's sign is incorrect. Chvostek's sign is indicative of hypocalcemia, not hypokalemia. While both hypocalcemia and hypokalemia can cause neuromuscular excitability, monitoring for Chvostek’s sign is not a priority in the management of hypokalemia.

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Correct Answer is A

Explanation

A. Placing the client in an orthopneic position is correct. The orthopneic position (sitting upright and leaning forward. helps clients with COPD breathe more easily by maximizing lung expansion and easing the work of breathing. This position is often used in clients with chronic respiratory conditions to alleviate dyspnea.

B. Providing the client with three large meals is incorrect. Clients with COPD may have difficulty eating large meals because it can interfere with breathing due to increased diaphragm pressure. Instead, small, frequent meals are recommended to reduce the workload on the respiratory system.

C. Encouraging the client to cough and deep breathe once every 8 hr is incorrect. In clients with COPD, frequent coughing and deep breathing exercises are important to promote airway clearance and lung expansion. The nurse should encourage these activities more often than every 8 hours, especially to help clear mucus.

D. Limiting fluid intake to 1,000 ml daily is incorrect. Adequate hydration is essential in COPD clients to help thin secretions and promote easier expectoration. A restriction on fluids could lead to thickened mucus and worsened respiratory status.

A. Use hot water to wash hands. B. Apply friction to hands for 10 seconds. C. Dry hands starting from forearm to fingers. D. Interlace the fingers while rubbing hands together.

Correct Answer is D

Explanation

A. Using hot water to wash hands is incorrect. Hot water can cause skin irritation and is not necessary for effective hand hygiene. The water temperature should be comfortable for the person washing their hands, whether it is warm or cool.

B. Applying friction to hands for 10 seconds is incorrect. Hand hygiene should be done for at least 20 seconds, not just 10 seconds, to effectively remove contaminants.

C. Drying hands starting from forearm to fingers is incorrect. Hands should be dried starting from the fingers to the forearms to avoid contamination from dripping water on the hands after washing. The goal is to maintain clean hands throughout the drying process.

D. Interlacing the fingers while rubbing hands together is correct. Interlacing the fingers and rubbing them together ensures that all surfaces of the hands, including between the fingers, are properly cleaned. This method is recommended in the CDC hand hygiene guidelines for thorough washing.

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A nurse is contributing to the plan of care for a client who has a potassium level of 2.9 mEq/L. Which of the following actions should the nurse plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is contributing to the plan of care for a client who has COPD. Which of the following interventions should the nurse include in the plan?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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