A nurse is reviewing laboratory values of a client with chronic renal failure and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate?

Administering sodium polystyrene sulfonate.

Initiating an IV potassium infusion.

Administering a potassium-sparing diuretic.

Encouraging the client to eat bananas.

Answer and Explanation

The Correct Answer is A

A. Administering sodium polystyrene sulfonate:
This medication removes potassium through the GI tract and is used to treat hyperkalemia.

B. Initiating an IV potassium infusion:
The client already has hyperkalemia; giving potassium would worsen it.

C. Administering a potassium-sparing diuretic:
These medications retain potassium and would further elevate potassium levels.

D. Encouraging the client to eat bananas:
Bananas are high in potassium and should be avoided in hyperkalemia.

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Correct Answer is B

Explanation

A. Oxygen saturation 93%:
While this is slightly below normal, it is not a definitive or specific indicator of fluid overload.

B. Distended neck veins:
Jugular vein distention is a classic sign of fluid overload and increased central venous pressure.

C. The client has gained 1 pound since yesterday:
A 1-pound weight gain could be due to fluid retention, but it's not significant enough on its own to confirm fluid overload.

D. Return of skin to previous position when the client's shin is palpated:
This indicates normal skin turgor and does not suggest fluid overload; instead, it rules out dehydration.

A. 2000mL/hour B. 16 liters C. 4 liters D. 8000 mL

Correct Answer is D

Explanation

Formula: 4 mL × Body weight (kg) × %TBSA

4 × 100 × 40 = 16,000 mL total in 24 hours

Half (8,000 mL) is given in the first 8 hours

Answer- 8000ml

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A nurse is reviewing laboratory values of a client with chronic renal failure and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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