Patient Data
The nurse is reviewing the history and physical.
Choose the most likely options for the information missing from the statement below by selecting from the list of options provided.
Based on the client's subjective and objectives data, the nurse recognizes that she is having signs and symptoms of a .
The Correct Answer is {"dropdown-group-1":"B"}
Choice A rationale:
Sinus tachycardia is not a cause, but a consequence of hyperkalemia.
Choice B rationale:
The client has a history of diabetes, hypertension, coronary artery disease, and end-stage renal disease, which are all risk factors for developing hyperkalemia (high levels of potassium in the blood). She also missed her scheduled dialysis session, which could have caused a buildup of potassium in her blood. Some of the signs and symptoms of hyperkalemia include fatigue, weakness, muscle cramps, tingling sensation in arms and legs, and cardiac arrhythmias such as sinus tachycardia (a fast heart rate). The other options are not consistent with the client's data or condition.
Choice C rationale:
Hypermagnesemia can also cause muscle weakness and cardiac arrhythmias, but they are less likely in this scenario since magnesium is not affected by dialysis
Choice D rationale:
Hypokalemia can also cause muscle weakness and cardiac arrhythmias, but they is less likely in this scenario since potassium is usually elevated in ESRD.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Preoccupation typically involves excessive thoughts or worries about a particular topic and may not directly manifest as physical symptoms like numbness and tingling.
Choice B rationale:
Reexperience often refers to the reliving of traumatic events through flashbacks or intrusive memories and is more closely associated with conditions like post-traumatic stress disorder (PTSD).
Choice C rationale:
Somatization refers to the expression of psychological distress through physical symptoms. In this case, the client's numbness and tingling on the right side of the body may be somatic symptoms related to the psychological distress and grief experienced after the spouse's death.
Choice D rationale:
Disorganization is not typically associated with physical symptoms like numbness and tingling. It may relate to cognitive or emotional difficulties but not to these specific physical sensations.
Correct Answer is B
Explanation
Choice A rationale:
Providing a supportive, structured environment for meals is an important aspect of the overall care plan for individuals with bulimia. However, it should not be the first intervention when a client is admitted with potential physical complications. Addressing the client's physical condition and safety is the initial priority.
Choice B rationale:
This is the correct initial intervention. Bulimia can lead to severe medical complications, including electrolyte imbalances, which can be life-threatening. Assessing the client's weight, vital signs, and electrolyte levels is crucial to determine the severity of physical issues and guide appropriate medical interventions.
Choice C rationale:
Discussing alternative strategies for binging and purging is an important aspect of treatment for bulimia, but it should follow the initial assessment of the client's physical condition. Addressing the client's medical needs takes precedence over discussing alternatives.
Choice D rationale:
While monitoring the client for possible vomiting is important in the care of individuals with bulimia, it should not be the first intervention when the client is admitted. Assessing the client's physical status and addressing potential medical complications should come before monitoring for specific behaviors.
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