Nokea
After teaching a group of nursing students about electrolyte imbalances, the instructor determines that the teaching was successful when the group identifies which of the following as indicative of hypercalcemia? Select all that apply.
- A. Constipation
- B. Oliguria
- C. Polydipsia
- D. Bone pain
- E. Anorexia
Correct Answer: A,C,D,E
Rationale: Signs and symptoms of hypercalcemia include anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, constipation, dehydration, muscle weakness and atrophy, stupor, coma, and cardiac arrest.
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A client who is prescribed digoxin (Lanoxin) is receiving electrolyte replacement therapy. The nurse would monitor the client for signs of digoxin toxicity if which of the following electrolytes is administered?
- A. Sodium
- B. Potassium
- C. Magnesium
- D. Phosphorous
Correct Answer: B
Rationale: The nurse should monitor a client taking digoxin (Lanoxin) for signs of digoxin toxicity if potassium is being given.
A nurse is caring for a client prescribed dextran IV. The nurse would observe the client for which of the following as a possible adverse reaction?
- A. Cyanosis
- B. Wheezing
- C. Hyperlipidemia
- D. Hypercoagulability
Correct Answer: B
Rationale: Dextran administration may result in allergic reactions, which are evidenced by urticaria, hypotension, nausea, vomiting, headache, dyspnea, fever, tightness of the chest, and wheezing.
A nurse is caring for a client who is receiving ammonium chloride. The nurse would be alert for the development of which of the following as a possible adverse reaction?
- A. Depressed reflexes
- B. Muscle weakness
- C. Circulatory collapse
- D. Metabolic acidosis
Correct Answer: D
Rationale: The nurse should monitor the client's condition for metabolic acidosis as an adverse reaction to ammonium chloride.
A physician orders levofloxacin (Levaquin) for a client to treat infection. The order is for levofloxacin (Levaquin) 500 mg/100 mL to be infused over a period of 1 hour. The IV infusion set has a drop factor of 10 drops/mL. The nurse would set the infusion flow rate at
- A. 16 drops/min
- B. 17 drops/min
- C. 18 drops/min
- D. 19 drops/min
Correct Answer: B
Rationale: 100 mL / 1 hour = 100 mL/hr; 100 mL/hr ? 1 hr/60 min = 1.67 mL/min; 1.67 mL/min ? 10 = 16.7 or 17 drops/min.
A client has developed electrolyte imbalances. The nurse understands that which of the following would most likely contribute to the client's current situation? Select all that apply.
- A. Vomiting
- B. Constipation
- C. Surgery
- D. Drug administration
- E. Diagnostic tests
Correct Answer: A,C,D,E
Rationale: The following can result in electrolyte imbalances in a client: vomiting, diarrhea, surgery, drug administration, and diagnostic tests.