Which assessment finding will the nurse expect for a patient with the following laboratory values: sodium 145 mEq/L, potassium 45 mq, calcium 45 mg/dL?
Light-headedness when standing up
Weak quadriceps muscles
Decreased deep tendon reflexes
Tingling of extremities
The Correct Answer is D
A. Light-headedness when standing up:
Elevated potassium levels (hyperkalemia) can lead to muscle weakness or paralysis, cardiac dysrhythmias, and even cardiac arrest. Light-headedness when standing up is more commonly associated with orthostatic hypotension or volume depletion rather than electrolyte imbalances like hyperkalemia.
B. Weak quadriceps muscles:
Weakness in the quadriceps muscles is not typically associated with the electrolyte imbalances presented in the scenario. Hyperkalemia can cause muscle weakness, but it is not specific to the quadriceps.
C. Decreased deep tendon reflexes:
Decreased deep tendon reflexes are not typically associated with the electrolyte imbalances presented in the scenario. Hyperkalemia can lead to hyperreflexia or absent reflexes, but it is not specific to decreased deep tendon reflexes.
D. Tingling of extremities:
This is the correct answer. Hypocalcemia, indicated by the low calcium level in the scenario, can manifest with symptoms such as tingling or numbness of the extremities, muscle cramps, and tetany. Calcium plays a crucial role in nerve transmission, and low levels can lead to sensory disturbances like tingling in the extremities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Helping the client select a low-salt diet:
This option is not directly related to addressing tenacious bronchial secretions in COPD. While a low-salt diet may be beneficial for managing conditions like hypertension or heart failure, it does not directly influence the viscosity of bronchial secretions.
B. Administering oxygen via nasal cannula at 2 L/min:
Oxygen therapy is important for clients with COPD, especially during exacerbations or periods of hypoxemia. However, in this scenario, the client's primary concern is tenacious bronchial secretions, and oxygen therapy alone may not effectively address this issue.
C. Encouraging the client to drink 2 to 3 L of water daily:
This is the correct answer. Increasing fluid intake helps to hydrate the mucous membranes and thin bronchial secretions, making them easier to expectorate. Adequate hydration is essential for optimizing the clearance of secretions in clients with COPD.
D. Maintaining a semi-Fowler's position as often as possible:
While maintaining a semi-Fowler's position can improve respiratory mechanics and reduce dyspnea in clients with COPD, it does not directly address the issue of tenacious bronchial secretions. This position primarily helps in optimizing lung expansion and facilitating easier breathing.
Correct Answer is C
Explanation
Answer: C. "I should expect the hospice team to help me manage my dyes."
A. "I will have to be admitted to a long-term care facility in order to receive hospice care."
This statement reflects a misunderstanding of hospice care. Hospice services can be provided in various settings, including the client’s home, hospice centers, or even long-term care facilities, but clients are not required to be admitted to a long-term care facility specifically to receive hospice care.
B. "My oncologist will continue to look for a cure for my cancer while I am receiving hospice care."
Hospice care focuses on comfort and quality of life for clients with terminal illnesses, rather than curative treatment. Clients receiving hospice care have typically decided to forego curative treatment to prioritize symptom management and palliative care.
C. "I should expect the hospice team to help me manage my dyes."
This statement indicates an understanding of hospice care. The hospice team provides comprehensive support to manage symptoms, such as pain and discomfort, as well as addressing emotional, spiritual, and psychosocial needs. The goal is to ensure the client’s comfort during the end of life.
D. "Hospice care services are available to patients who are terminally ill regardless of their life expectancy."
This is not entirely accurate. Hospice care is typically available to individuals who have a life expectancy of six months or less, as determined by their healthcare provider. Therefore, life expectancy is an important criterion for hospice eligibility.
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