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Hypocalcemia, or low blood calcium, results from impaired parathyroid function or vitamin D deficiency, causing muscle cramps and tetany. Laxative abuse primarily causes potassium loss through diarrhea, not calcium. Calcium homeostasis is tightly regulated, and laxative-induced diarrhea does not significantly deplete calcium, making this an unlikely cause of the client’s symptoms.

Hyperkalemia, elevated blood potassium, occurs in conditions like renal failure or excessive potassium intake. Laxative abuse leads to potassium loss via frequent bowel movements, causing hypokalemia, not hyperkalemia. High potassium can cause cardiac arrhythmias, but the client’s fatigue and weakness align more closely with low potassium levels.

Hypernatremia, high blood sodium, results from dehydration or excessive sodium intake. While laxative abuse can cause dehydration, the primary electrolyte loss is potassium, not sodium retention. Hypernatremia may cause neurological symptoms like confusion, but the client’s fatigue and weakness are more characteristic of hypokalemia than hypernatremia.

Instructing on walker movement addresses the psychomotor domain, focusing on physical skills. This does not tackle the client’s emotional disengagement or belief of being “too old.” Without addressing motivation, technical instructions may be ineffective, as the client’s psychological barrier prevents engagement, reducing the likelihood of successful learning and adoption.

Explaining walker support for lower extremities focuses on the cognitive domain, providing technical knowledge. While informative, it does not address the client’s emotional disengagement. Without motivating the client by linking the walker to personal benefits, this approach may fail to overcome their resistance, as it lacks an emotional or motivational component.

Discussing the rationale for walker use targets the cognitive domain, explaining its purpose. While this may enhance understanding, it does not address the client’s emotional barrier or lack of motivation. Without engaging the client’s feelings or highlighting personal benefits, the rationale alone is unlikely to inspire willingness to learn or use the walker.

10% Dextrose is a hypertonic solution used for caloric supplementation or hypoglycemia treatment. It can cause hyperglycemia and fluid shifts, making it unsuitable for routine preoperative hydration. Surgical patients need balanced electrolyte solutions to replace fluid losses and maintain homeostasis, which 10% dextrose does not provide effectively.

3% NaCl, a hypertonic saline, is used for severe hyponatremia or cerebral edema. It risks causing hypernatremia and fluid overload if not carefully monitored. Preoperative patients typically require isotonic fluids to maintain electrolyte balance and hydration, making 3% NaCl inappropriate for standard surgical preparation.

0.45% NaCl, a hypotonic solution, is used for maintenance hydration or hypernatremia correction. It provides less sodium than needed for surgical fluid replacement and may cause hyponatremia or fluid shifts. Isotonic fluids like Lactated Ringer’s are preferred preoperatively to ensure electrolyte stability and adequate hydration.

Alprazolam, a benzodiazepine, reduces anxiety but carries risks like sedation and falls in dementia patients. Pharmacological interventions should be secondary to non-pharmacological approaches, as they may exacerbate confusion or dependency. Addressing emotional distress through engagement is preferred before considering medications for anxiety management.

Olanzapine, an antipsychotic, is used for severe agitation or psychosis in dementia. It poses risks like sedation, extrapyramidal symptoms, and increased mortality in elderly patients. Non-pharmacological interventions, like redirection, are prioritized to manage emotional distress safely, reserving medications for when behavioral approaches fail.

Isolating the client in their room may increase distress and agitation in dementia patients, as it does not address their emotional needs. Social isolation can worsen confusion and feelings of abandonment. Therapeutic engagement, such as redirection or validation, is more effective in calming the client and fostering trust.

Caregiver role strain addresses the burden on parents or guardians. While important, it is not the highest priority compared to the client’s direct health needs. Developmental issues in a child take precedence, as they can have long-term impacts on physical, cognitive, and social growth, requiring immediate intervention.

Sleep deprivation can affect health and development but is less urgent than developmental delays, which have broader, long-term consequences. Sleep issues may contribute to developmental problems but are typically secondary. Addressing underlying causes, like developmental risks, often resolves related symptoms like poor sleep more effectively.

Altered urinary elimination, such as incontinence, may indicate a medical issue but is generally less critical than developmental delays in a pediatric client. It may be a symptom of developmental issues but does not take precedence over addressing potential delays that impact overall growth and function.

Hyponatremia, low sodium (normal 135–145 mEq/L), is not indicated, as the sodium level is 140 mEq/L, within normal limits. Hyponatremia can cause neurological symptoms like confusion, but the lab values do not support this diagnosis, and magnesium imbalance is the clear abnormality.

Hyperchloremia, high chloride (normal 98–106 mEq/L), is not present, as the chloride level is 107 mEq/L, just above normal and not clinically significant. Elevated chloride may occur in dehydration or renal issues, but the primary concern here is the significantly low magnesium level.

Hypokalemia, low potassium (normal 3.5–5.0 mEq/L), is not indicated, as the potassium level is 3.6 mEq/L, within normal range. Hypokalemia causes muscle weakness and arrhythmias, but the lab values point to hypomagnesemia as the primary electrolyte imbalance in this case.

Hyperchloremia, elevated chloride levels, is associated with metabolic acidosis or dehydration, not neuromuscular symptoms like wrist flexion. Chloride imbalances affect acid-base balance, not calcium-dependent muscle contractions. The inward wrist flexion suggests a neuromuscular excitability issue, which is more characteristic of low calcium levels than chloride abnormalities.

Hypercalcemia, high calcium levels, causes muscle weakness, lethargy, and reduced reflexes, not increased neuromuscular excitability like wrist flexion. Calcium excess stabilizes nerve membranes, reducing spasms. The symptom described aligns with hypocalcemia, where low calcium increases nerve excitability, leading to tetany or abnormal muscle contractions.

Hypomagnesemia, low magnesium, can cause neuromuscular symptoms like tremors or seizures but is less commonly associated with specific signs like wrist flexion. Magnesium affects muscle relaxation, and its deficiency typically causes generalized excitability. Hypocalcemia is more directly linked to tetany and carpopedal spasms, as seen in the client.

Hyperchloremia, elevated chloride levels, is associated with metabolic acidosis or dehydration, not neuromuscular symptoms like wrist flexion. Chloride imbalances affect acid-base balance, not calcium-dependent muscle contractions. The inward wrist flexion suggests a neuromuscular excitability issue, which is more characteristic of low calcium levels than chloride abnormalities.

Hypercalcemia, high calcium levels, causes muscle weakness, lethargy, and reduced reflexes, not increased neuromuscular excitability like wrist flexion. Calcium excess stabilizes nerve membranes, reducing spasms. The symptom described aligns with hypocalcemia, where low calcium increases nerve excitability, leading to tetany or abnormal muscle contractions.

Hypomagnesemia, low magnesium, can cause neuromuscular symptoms like tremors or seizures but is less commonly associated with specific signs like wrist flexion. Magnesium affects muscle relaxation, and its deficiency typically causes generalized excitability. Hypocalcemia is more directly linked to tetany and carpopedal spasms, as seen in the client.

Hyponatremia, low sodium (normal 135–145 mEq/L), is not indicated, as the sodium level is 140 mEq/L, within normal limits. Hyponatremia can cause neurological symptoms like confusion, but the lab values do not support this diagnosis, and magnesium imbalance is the clear abnormality.

Hyperchloremia, high chloride (normal 98–106 mEq/L), is not present, as the chloride level is 107 mEq/L, just above normal and not clinically significant. Elevated chloride may occur in dehydration or renal issues, but the primary concern here is the significantly low magnesium level.

Hypokalemia, low potassium (normal 3.5–5.0 mEq/L), is not indicated, as the potassium level is 3.6 mEq/L, within normal range. Hypokalemia causes muscle weakness and arrhythmias, but the lab values point to hypomagnesemia as the primary electrolyte imbalance in this case.

The cognitive domain involves knowledge and understanding, such as explaining the procedure or its rationale. The client’s statement indicates understanding (“I understand”), so their concern is not about knowledge but emotional worries about pain and appearance, which are better addressed in the affective domain to provide emotional support.

The psychomotor domain focuses on physical skills, like performing a task or procedure. The client’s concerns about pain and appearance are emotional, not skill-based. Addressing psychomotor skills, such as teaching self-care techniques, is irrelevant to the client’s expressed emotional worries, requiring a focus on feelings instead.

The behavioral domain is not a standard learning domain in nursing education (cognitive, psychomotor, affective are typical). If interpreted as behavior modification, it is irrelevant here, as the client’s concerns are emotional, not behavioral. The nurse should focus on addressing the client’s feelings rather than attempting to change behaviors.