NR-226 Patient Care Fundamentals - Set 3 - Part 1

Correct Answer: Hypocalcemia from parathyroid gland injury

The four parathyroid glands lie on the posterior thyroid and are easily bruised or removed during thyroidectomy. Parathyroid hormone falls, so calcium drops. Perioral and fingertip tingling is the earliest warning. Option a is incorrect because potassium is handled by the kidney and by insulin and acid base shifts, none of which neck surgery disturbs. Thyroid surgery does not alter renal potassium excretion. Option b is incorrect because a rising sodium requires water loss or sodium gain, and this client has neither. Free water balance depends on antidiuretic hormone and thirst, which the thyroid gland does not control. Option d is incorrect because losing parathyroid hormone reduces vitamin D activation rather than increasing it. Phosphate does climb after these operations, but the reason is lost hormone, not extra vitamin D activity.

Correct Answer: Drink water on a set schedule daily

The thirst mechanism blunts with age, so an older adult can be significantly water depleted before feeling thirsty. Drinking on a fixed schedule, with extra free water during heat and exertion, keeps the sodium from climbing. Option b is incorrect because withholding fluid through the hottest part of the day is when losses are greatest. Sweat carries away water faster than sodium, so delaying intake accelerates exactly the deficit this client keeps developing. Option c is incorrect because salt tablets add solute the kidney must excrete with water it does not have. They appear in the causes of high sodium, so this instruction would push the level higher. Option d is incorrect because thirst is the very warning signal that fails in older adults. Relying on a blunted cue means intake starts only after cells have already dehydrated and the sodium has risen.

Correct Answer: Tremor means low magnesium, weakness means low phosphate

Magnesium is a membrane stabilizer, so its loss produces tremor, twitching and a positive Trousseau's sign. Phosphate is fuel, so its loss produces energy failure, seen as weakness and a diaphragm that cannot work. Option a is incorrect because a phosphate deficit leaves reflexes normal and never produces tetany. The client with a positive Trousseau's sign has something else going on, and that something is the magnesium. Option b is incorrect because the labels are swapped. Low magnesium destabilizes membranes and causes the tremor and spasm; low phosphate starves muscle of energy and causes the weakness and poor respiratory effort. Option d is incorrect because weakness with intact reflexes does not fit a magnesium deficit, which drives reflexes upward. Heavy drinking depletes several minerals at once, so two different pictures are entirely expected.

Correct Answer: A tube fed client who is newly restless

New restlessness in a tube fed client is the early neurologic sign of a rising sodium, and it progresses toward lethargy, seizure and coma. A change in mental status outranks thirst, cramps and comfort requests. Option b is incorrect because thirst on a fluid restriction is expected and can be eased with oral care once the higher priority is settled. Discomfort matters, but it does not signal a brain that is changing. Option c is incorrect because cramping reflects an altered muscle membrane potential and is uncomfortable rather than dangerous. Mild hyponatremia without mental status change can safely wait behind a client showing early cerebral involvement. Option d is incorrect because a client who can ask for water is alert and acting on an intact thirst mechanism. Meeting that request is appropriate, but it carries no urgency compared with a new mental status change.

Correct Answer: Abnormal values with a normal pH mean full compensation

Compensation exists only when a primary abnormality is being offset. Here both the respiratory and metabolic values sit far outside their ranges while the pH has returned to range, which defines a fully compensated chronic disorder. Option a is incorrect because a gas is only normal when the pH, the carbon dioxide, and the bicarbonate are all in range. Reading the pH alone hides a client whose lungs and kidneys are both far from baseline. Option b is incorrect because the pH sits in the acidic half of its range, below the midpoint. That lean identifies the acidosis as primary, so the raised bicarbonate is renal compensation rather than the culprit. Option c is incorrect because a mixed disorder shows the two values pushing the pH the same way. In this gas the high carbon dioxide is acidic while the high bicarbonate is alkaline, so they oppose each other.

Correct Answer: Start titrated oxygen and monitor level of consciousness

Hypoxemia is never left untreated. Oxygen is titrated to a saturation of roughly 88 to 92 percent in a known retainer, and the nurse watches the level of consciousness for signs of a rising carbon dioxide. Option a is incorrect because withholding oxygen from a hypoxemic client is dangerous and indefensible. The old hypoxic drive teaching has been set aside; careful titration, not deprivation, is what protects this client. Option b is incorrect because flooding a known retainer with high flow oxygen worsens ventilation and perfusion matching and can push the carbon dioxide upward. A controlled device such as a Venturi mask suits this client. Option d is incorrect because pursed lip breathing belongs in the teaching plan for stable disease. Delaying oxygen for an hour in a saturation this low leaves tissue oxygen delivery unsupported while the exacerbation progresses.

Correct Answer: Shallow respirations with a weak cough

Diaphragm and intercostal weakness from hypokalemia produces shallow breathing and an ineffective cough, threatening airway clearance and ventilation. Airway and breathing outrank the neuromuscular and gastrointestinal findings, all of which are expected here. Option b is incorrect because ascending weakness starting in the legs is the classic hypokalemic pattern and is anticipated at this level. It needs monitoring and fall precautions, not an immediate intervention. Option c is incorrect because sluggish bowel sounds and distention reflect the same smooth muscle slowing. They matter chiefly as a reason to withhold oral potassium, which does not make them the most urgent finding. Option d is incorrect because orthostatic dizziness comes from reduced vascular tone and contractility, a real safety concern handled with slow position changes. Ventilation is compromised sooner and carries the greater immediate threat.

Correct Answer: Infusing isotonic sodium chloride to restore volume

Flat neck veins, dry membranes and orthostasis mark hypovolemic hyponatremia, where sodium and water were both lost through the gut. Isotonic sodium chloride replaces both at once and corrects volume and sodium together. Option a is incorrect because fluid restriction belongs to the euvolemic and hypervolemic subtypes, where excess water is the problem. Withholding fluid from a client who is already volume depleted would deepen the deficit and worsen perfusion. Option b is incorrect because diuresis is reserved for the client overloaded with water, such as one in heart failure. Pulling more fluid from an orthostatic client invites hypotension and acute kidney injury. Option d is incorrect because three percent saline is held for severe symptomatic hyponatremia with seizures or obtundation. This client is dizzy but alert, so isotonic replacement carries the benefit without the demyelination risk.

Correct Answer: A rapid fall as potassium enters cells

Insulin activates the sodium-potassium pump and drives potassium into cells, so the serum level falls quickly once the infusion starts. Total body potassium was already depleted by the acidosis and osmotic diuresis. Option b is incorrect because correcting the acidosis moves hydrogen back out of cells and potassium back in, lowering the serum value. A rising potassium during treatment would signal something other than the expected response. Option c is incorrect because it treats the number as stable when it is the most volatile value in this admission. Hourly monitoring exists precisely because the level moves within the first hour. Option d is incorrect because the sequence is backwards and the timing far too slow. Potassium begins moving inward as soon as insulin reaches the cell, which is why replacement is often added to the fluids.

Correct Answer: Hold the digoxin and notify the provider

Nausea with yellow-green halos is digoxin toxicity, and the low potassium is what precipitated it, since potassium and digoxin compete for the same pump site. Holding the drug and reporting comes first. Option a is incorrect because giving another dose to a client already showing visual and gastrointestinal signs of toxicity deepens the poisoning. The drug must stop before any further laboratory follow-up. Option b is incorrect because dietary potassium works far too slowly for a client who is symptomatic now. Food has a place in long-term maintenance, not in the immediate response to suspected toxicity. Option c is incorrect because these are not findings to watch and record. Halos, nausea and a potassium below normal in a digitalized client signal an urgent drug problem that demands action.

Correct Answer: The serum magnesium level

Hypomagnesemia causes renal potassium wasting, and potassium cannot be corrected until the magnesium is replaced. Refractory hypokalemia despite repeated doses points to a low magnesium until that value has been checked. Option a is incorrect because chloride usually falls alongside potassium and is the reason potassium chloride is the salt chosen for replacement. Knowing the chloride does not explain why the replacement is failing. Option c is incorrect because phosphate tracks inversely with calcium and shifts during refeeding. Neither of those mechanisms holds potassium down in the way a depleted magnesium store does. Option d is incorrect because albumin binds calcium, not potassium. It is the value to check when a total calcium looks low in a malnourished client, which is a different problem entirely.

Correct Answer: Weakness, constipation and diminished deep tendon reflexes

Calcium stabilizes excitable membranes, so an excess raises the firing threshold and everything slows. Skeletal muscle weakens, reflexes fade, and smooth muscle in the bowel quiets, producing constipation and eventually ileus. Option b is incorrect because that cluster belongs to a calcium deficit. Losing the stabilizer lowers the threshold, so nerves and gut become irritable rather than sluggish, which is the reverse of this client's problem. Option c is incorrect because tetany, stridor and QT lengthening describe severe hypocalcemia. A calcium excess shortens the QT interval, and laryngeal spasm requires a fall in calcium, not a rise. Option d is incorrect because a twitching cheek with tremor and seizures points toward low calcium or low magnesium. Both are membrane stabilizers, and both deficits produce excitation; an excess produces the opposite picture.

Correct Answer: Metabolic alkalosis from loss of gastric acid

Gastric fluid is hydrochloric acid. Removing it continuously strips hydrogen ion and chloride from the body, leaving the plasma relatively rich in bicarbonate, so the pH rises and a metabolic alkalosis develops. Option a is incorrect because splinting after abdominal surgery can raise carbon dioxide, yet the dominant loss here is stomach acid. The bicarbonate excess drives this gas, and the pH climbs rather than falls. Option b is incorrect because bicarbonate-rich fluid sits below the stomach, in the small intestine and pancreas. Suction placed in the stomach removes acid, so bicarbonate is spared rather than drained away. Option c is incorrect because hyperventilation from pain would lower carbon dioxide and cause a respiratory picture. Post-operative pain is worth treating, but it does not account for the continuous removal of hydrochloric acid.

Correct Answer: A serum potassium below the normal range

Beta-agonists drive potassium into cells, and vomiting removes potassium in gastric fluid while the resulting alkalosis shifts more of it inward. Three mechanisms push the same direction, so the level falls. Option a is incorrect because nothing in this history holds potassium in the serum. A rising level would require impaired renal excretion, cell lysis or acidosis, and none of those is present here. Option b is incorrect because serum potassium is a volatile value that moves within minutes of a transcellular shift. Expecting no change ignores both the drug effect and the days of gastric loss. Option d is incorrect because it points the value the wrong way. Both the inhaler and the vomiting subtract potassium from the extracellular space, so the result should sit low rather than near the ceiling.

Correct Answer: The neurologic system, from brain swelling

Sodium is the main osmotically active particle outside the cell, so a falling serum sodium pulls water into cells. Brain cells swelling inside a rigid skull produce the earliest and most dangerous findings. Option b is incorrect because the kidney regulates sodium rather than being injured by a falling level. Renal tubular damage arises from ischemia, nephrotoxins and obstruction, none of which a low sodium concentration produces. Option c is incorrect because alveolar collapse belongs to atelectasis and surfactant problems. Respiratory failure enters a sodium disorder only late, when a seizure or deep obtundation threatens the airway, not as the first system affected. Option d is incorrect because bone demineralization is a calcium and phosphate problem tied to parathyroid hormone. Muscle cramping can accompany low sodium, but it follows the water shift and never precedes the neurologic changes.

Correct Answer: I still eat extra bananas and potatoes each day.

Loop diuretics waste potassium, so extra potassium-rich food made sense on furosemide. Spironolactone spares potassium, so continuing that diet now risks hyperkalemia, and the teaching must change with the drug. Option a is incorrect because those are precisely the findings to watch for on a potassium-sparing diuretic. Weakness and a slow irregular pulse are how a rising potassium first announces itself at home. Option b is incorrect because regular monitoring is a requirement, not an error. Anyone taking a drug that blocks aldosterone needs scheduled potassium draws, and this client has understood that part of the plan. Option c is incorrect because checking first is exactly right. Herbal and electrolyte products can carry potassium loads that would be unremarkable in a healthy adult but dangerous alongside spironolactone.

Correct Answer: The normal range is narrow, so small changes become dangerous.

The whole normal potassium range spans about one and a half milliequivalents per liter, so a shift that would be trivial for sodium can produce lethal dysrhythmias. That narrow window drives high-alert handling. Option a is incorrect because roughly ninety-eight percent of body potassium sits inside cells and only about two percent circulates. A serum value is a poor mirror of the total body store. Option c is incorrect because the kidney is an efficient regulator, clearing roughly ninety percent of dietary potassium each day. Efficient clearance does not widen the safe range; it is what keeps a narrow one workable. Option d is incorrect because both a low and a high potassium threaten the myocardium. Hypokalemia invites ventricular ectopy and torsades, while hyperkalemia slows conduction toward fibrillation or asystole.

Correct Answer: Hypernatremia, because cells are losing water

Dry sticky membranes and a furrowed tongue mean water has been pulled out of cells, and brisk reflexes with twitching reflect the hyperexcitability of a hyperosmolar state. Together they point to hypernatremia, not dilution. Option a is incorrect because swelling brain cells would come with moist membranes and a normal or plump tongue. Water moving into cells cannot produce the dried oral tissue described, so the direction of the shift is wrong. Option b is incorrect because diminished reflexes are not a reliable feature of low sodium. Severe hyponatremia is described with neuromuscular hyperexcitability instead, and reflex changes discriminate the calcium and magnesium disorders rather than the sodium ones. Option d is incorrect because fluid excess shows edema, crackles, distended neck veins and weight gain. Every finding listed here points the other way, toward a body that has lost water rather than gained it.

Correct Answer: Offer fluids often and record the intake

Encouraging oral fluids and recording intake are routine supportive tasks with a predictable outcome, well within assistive personnel scope. Hydration is central to hypercalcemia care, and the nurse keeps responsibility for evaluating the results. Option a is incorrect because neurologic assessment of a confused client demands interpretation and comparison with earlier findings. Assistive personnel may report what they observe, but the assessment itself is never assigned away. Option c is incorrect because withholding a prescribed medication is a licensed judgment resting on the calcium result and the client's condition. Nursing assistants do not administer or hold drugs at any time. Option d is incorrect because teaching physiology to a client requires licensed knowledge and evaluation of understanding. Reinforcing an instruction the nurse has already delivered is acceptable; originating the explanation is not.

Correct Answer: The client with chronic heavy alcohol use

Chronic alcohol use is the classic cause because it strips magnesium three ways at once, through poor dietary intake, gastrointestinal losses, and direct renal wasting. Roughly a third of these clients are deficient. Option a is incorrect because failing kidneys retain magnesium instead of losing it. Renal failure is the leading cause of a high magnesium, which is the opposite of the deficiency the nurse is hunting. Option b is incorrect because swallowing magnesium every night adds to the body pool. Products such as milk of magnesia raise the level, and they become dangerous only when the kidneys cannot clear them. Option d is incorrect because short term maintenance fluid after an uncomplicated operation does not deplete a mineral stored largely in bone and cells. This history carries no mechanism for magnesium loss.