Nokea
A client was admitted to the emergency department due to low serum calcium levels. Upon further examination, the client demonstrates carpopedal spasms and reports numbness in their lips and hands. An ECG revealed a prolonged QT interval. Based on this information, the nurse should suspect which condition?
- A. Hyperthyroidism
- B. Hypothyroidism
- C. Hyperparathyroidism
- D. Hypoparathyroidism
Correct Answer: D
Rationale: Hypoparathyroidism leads to low serum calcium levels, causing symptoms like carpopedal spasms, numbness, and prolonged QT interval due to decreased parathyroid hormone.
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The nurse is caring for a client who has fluid volume deficit receiving intravenous fluids. Which of the following would indicate the client is achieving the treatment goals?
- A. urine output 20 mL/hr
- B. BUN 15 mg/dL (5.355 mmol/L) [10-20 mg/dL (3.6-7.1 mmol/L)]
- C. urine specific gravity 1.039 [1.005-1.030]
- D. flattened jugular veins
Correct Answer: B
Rationale: Normal BUN (15 mg/dL) indicates improved renal perfusion and fluid balance, suggesting effective treatment for fluid volume deficit.
The nurse is teaching a client with hypercalcemia appropriate dietary measures. Which food selections by the client would require follow-up by the nurse? Select all that apply.
- A. broccoli
- B. 2% milk
- C. whole wheat pasta
- D. bananas
- E. seafood
Correct Answer: B
Rationale: Milk is high in calcium and should be limited in hypercalcemia to prevent worsening the condition.
The nurse is caring for a client with hypokalemia scheduled to receive the prescribed 20 mEq of intravenous (IV) potassium. Which client assessment requires notification of the primary healthcare provider (PHCP)?
- A. Oliguria
- B. Abdominal distention
- C. Muscle weakness
- D. Weak peripheral pulses
Correct Answer: A
Rationale: Oliguria indicates poor renal function, which can lead to potassium accumulation, requiring PHCP notification before IV potassium administration.
The nurse cares for a client diagnosed with end-stage renal disease who just returned from initial hemodialysis. Which of the following assessment findings is of the highest concern?
- A. Headache and nausea
- B. Scant blood on the AV fistula
- C. Potassium 3.7 mEq/L (mmol/L) [3.5-5.0 mEq/L, mmol/L]
- D. Hemoglobin 8.8 g/dL [Male: 14-18 g/dL; Female: 12-16 g/dL, Female 115-155 g/L Male 125-170 g/L]
Correct Answer: A
Rationale: Headache and nausea may indicate dialysis disequilibrium syndrome, a serious complication requiring immediate attention.
The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 2 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
The nurse focuses on the client's serum sodium level and recognizes which conditions may cause hyponatremia or hypernatremia. For each condition below, click to specify if it causes hyponatremia or hypernatremia.
- A. syndrome of inappropriate antidiuretic hormone (SIADH)
- B. diabetes insipidus (DI)
- C. adrenal insufficiency
- D. Cushing's syndrome
Correct Answer: A: Hyponatremia, B: Hypernatremia, C: Hyponatremia, D: Hypernatremia
Rationale: SIADH and adrenal insufficiency cause hyponatremia via water retention or sodium loss. DI and Cushing's syndrome cause hypernatremia via water loss or sodium retention.