A patient is admitted with hypernatremia caused by being stranded on a boat in the Atlantic Ocean for five days without a fresh water source. What is this patient at risk for developing?
Stress fractures.
Cerebral bleeding.
Atrial dysrhythmias.
Pulmonary edema.
The Correct Answer is B
Cerebral bleeding. Choice A rationale:
Stress fractures are not directly related to hypernatremia. Hypernatremia is an electrolyte imbalance, and its main effects are related to cellular dehydration and neurological symptoms rather than bone fractures.
Choice B rationale:
This is the correct answer because hypernatremia can lead to severe dehydration and cause neurological complications, including cerebral bleeding. The brain cells can shrink due to water loss, causing blood vessels to rupture, leading to bleeding in the brain.
Choice C rationale:
Atrial dysrhythmias are not directly associated with hypernatremia. Hypernatremia primarily affects the central nervous system and can lead to neurological symptoms rather than cardiac dysrhythmias.
Choice D rationale:
Pulmonary edema is not a likely consequence of hypernatremia. Pulmonary edema is associated with fluid volume excess, not fluid volume deficit, which is characteristic of hypernatremia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Hypernatremia.
Choice A rationale:
Hypernatremia is the most likely condition the client is experiencing based on the laboratory result of Sodium 144 mEq/L, which is above the normal range of 136 to 145 mEq/L. Hypernatremia is an elevated sodium level in the blood and can cause various symptoms like extreme thirst, dry mucous membranes, and altered mental status.
Choice B rationale:
To address hypernatremia, the nurse should take two actions. Action 1: Prepare to check a serum albumin level. This is important as hypernatremia can be caused by a relative water deficit due to excess solutes, and measuring serum albumin helps assess the body's water balance. Action 2: Request a STAT ECG. Hypernatremia can lead to cardiac arrhythmias, so an ECG is essential to monitor the patient's heart rhythm. Parameters to Monitor: Parameter 1 - Serum bicarbonate level: Monitoring bicarbonate levels helps evaluate acid-base balance and assess the impact of hypernatremia on the body's buffering systems. Parameter 2 - Intake and Output: Monitoring the patient's fluid intake and output is crucial to ensure proper hydration and track response to treatment.
Correct Answer is {"dropdown-group-1":"C"}
Explanation
Choice A rationale:
Target conditions are not mentioned in the sentence, and there is no context to suggest their relevance to the client's situation.
Choice B rationale:
Hyperactive reflexes are not commonly associated with a urinary tract infection or the prescribed medications.
Choice C rationale:
The client with a urinary tract infection and the medications mentioned (Furosemide and Trimethoprim/sulfamethoxazole) are at an increased risk of hypokalemia (low potassium levels) due to Furosemide's diuretic effect, fluid volume deficit (dehydration) from the infection, and hypertension (high blood pressure) as a potential side effect of Trimethoprim/sulfamethoxazole.
Choice D rationale:
Urinary retention is not expected in a client with a urinary tract infection; it is more commonly associated with urinary obstruction or other urinary conditions unrelated to an infection.
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