NR-324 Adult Health I - Set 1 - Part 1

Correct Answer: Use a lift sheet and move slowly

Calcium in the blood of a client with myeloma has come out of bone, leaving a demineralised skeleton at risk of pathological fracture. A lift sheet and unhurried movement spread load and avoid traction on limbs. Option a is incorrect because traction on the arms concentrates force through weakened humeri and can snap one during an ordinary transfer. Limbs are never used as handles in a client with demineralised bone. Option b is incorrect because hypercalcemia produces muscle weakness, lethargy and confusion, so an unassisted transfer invites a fall. Mobility is encouraged once it is safe, but always with hands and equipment nearby. Option d is incorrect because a single weight bearing leg carries the whole body through a femur that may already be weakened. Pivoting also twists the hip, which is a classic mechanism for fracture.

Correct Answer: Diminished deep tendon reflexes and weakness

Magnesium is cleared by the kidney, so a damaged kidney plus a magnesium laxative raises the level. High magnesium blocks acetylcholine release at the neuromuscular junction, so reflexes fade and skeletal muscle becomes weak. Option a is incorrect because brisk reflexes and tremor belong to a magnesium deficit. This client has the opposite problem, and expecting hyperreflexia would hide the very finding used to judge how high the level has climbed. Option b is incorrect because carpopedal spasm is a sign of neuromuscular irritability seen when calcium or magnesium falls. Excess magnesium sedates the same tissue, so Chvostek and Trousseau signs stay negative here. Option c is incorrect because a fast heart rate with rising pressure describes the unsedated picture of hypomagnesemia. Rising magnesium slows conduction and dilates vessels, which is why this client is already hypotensive and lethargic.

Correct Answer: Shallow respirations with frequent ventricular ectopy

Respiratory muscle weakness and ventricular ectopy are the two findings that can kill this client within minutes. Severe hypokalemia below two point five mEq per L threatens both breathing and cardiac rhythm, so this pair is reported at once. Option b is incorrect because cramps and reduced grip strength confirm the diagnosis but sit on a slower trajectory. They call for fall precautions and replacement rather than emergency intervention in the next few minutes. Option c is incorrect because a silent, distended abdomen reflects the ileus that low potassium causes in smooth muscle. It is uncomfortable and needs treatment, yet it does not threaten the airway or the heartbeat. Option d is incorrect because eighty milliliters an hour is an adequate flow that actually clears the client for intravenous replacement. Good urine output is reassuring here rather than a reason to act urgently.

Correct Answer: Injecting potassium into a hanging bag

Potassium chloride is dense and sinks to the bottom of a bag that is already hanging, so the client receives a concentrated bolus. It must be added before the bag is hung and mixed by inverting it. Option a is incorrect because potassium chloride carries a high alert classification, and an independent double check of drug, concentration and pump rate is exactly the safeguard policy requires before the infusion starts. Option b is incorrect because premixed bags are the preferred product precisely because they remove the chance of a mixing error. Concentrated vials should not be stocked on a general unit at all. Option d is incorrect because the kidney is the only meaningful exit route for potassium, so checking that the client is making at least thirty milliliters an hour is a required step before hanging it.

Correct Answer: Alkalemia with a high bicarbonate and low potassium

Vomiting drains hydrochloric acid, chloride and volume, so bicarbonate is left in excess and the pH rises. Alkalemia also drives potassium into cells, producing the hypokalaemia that accompanies this disorder. Option b is incorrect because that pattern describes metabolic acidosis, which follows diarrhea rather than vomiting. Stool below the stomach is rich in bicarbonate, so losing it depletes base instead of acid. Option c is incorrect because a bicarbonate that has fallen cannot produce alkalemia; the two halves of this choice contradict each other. Losing gastric acid leaves bicarbonate higher, never lower. Option d is incorrect because a raised bicarbonate raises the pH rather than lowering it, and hydrogen only pushes potassium out of cells when acid is abundant. Both halves are reversed here.

Correct Answer: Respiratory acidosis that is partially compensated

The pH is still outside the normal range, so compensation is incomplete. The raised bicarbonate shows the kidneys working, which fits a four-day history, since renal compensation needs days rather than minutes. Option a is incorrect because full compensation would have carried the pH back inside 7.35 to 7.45. This client remains acidemic, so the kidneys have not yet finished their work. Option b is incorrect because alkalosis cannot explain an acidemic pH. The raised bicarbonate looks alkalotic in isolation, yet the direction of the pH assigns it the role of compensator. Option d is incorrect because an uncompensated gas keeps the bicarbonate inside 22 to 26. This bicarbonate has already risen, which shows renal compensation is under way after several days.

Correct Answer: Half normal saline running slowly overnight

Half normal saline is hypotonic and drives water into brain cells, worsening cerebral edema and intracranial pressure. Hypotonic fluid is contraindicated in head injury, raised intracranial pressure, burns and major trauma. Option a is incorrect because normal saline is isotonic, stays in the extracellular space and does not swell brain cells. It is a standard choice for a head injured client who needs volume. Option b is incorrect because lactated Ringer's is also isotonic relative to extracellular fluid and produces no net water shift into neurons. Its lactate converts to bicarbonate, which is useful when acidosis is a concern. Option c is incorrect because hypertonic saline pulls water out of swollen brain cells and is deliberately used to reduce cerebral edema. Given on a pump through a large vein, it is appropriate rather than questionable here.

Correct Answer: A pH of 7.38

Normal arterial pH runs from 7.35 to 7.45, with 7.40 as the midpoint. A pH of 7.38 sits inside that band, so the blood is neither acidemic nor alkalemic. Option b is incorrect because 7.31 falls below the lower limit of 7.35 and therefore defines acidemia. The nurse would need to look further at the carbon dioxide and bicarbonate to name the process. Option c is incorrect because 7.48 has crossed the upper limit of 7.45, which the laboratory reports as alkalemia rather than a normal result. Tingling fingers and rapid breathing often accompany that finding. Option d is incorrect because 7.52 is well above the normal ceiling and represents marked alkalemia. Values this far out of range usually signal an untreated primary disorder that demands prompt investigation.

Correct Answer: Hypoactive bowel sounds with constipation

A low potassium hyperpolarizes cells, so they sit further from threshold and are harder to fire. Smooth muscle in the gut slows, producing hypoactive bowel sounds, constipation and distension, which matches the low and slow pattern. Option a is incorrect because a rising potassium speeds gut motility and produces cramping with loose stools. Bowel sounds separate the two potassium disorders cleanly, and this client sits at the opposite end of the range. Option b is incorrect because reflexes are diminished rather than brisk when potassium is low. The muscle is difficult to excite, which is why weakness, limp limbs and hyporeflexia appear together in this imbalance. Option c is incorrect because a tall peaked T wave signals a high potassium, not a low one. The strip in hypokalemia shows a flattened T with a prominent U wave appearing after it.

Correct Answer: Hyperactive deep tendon reflexes and muscle cramping

A total calcium below 8.5 mg/dL with a normal albumin is true hypocalcemia. Ionized calcium no longer stabilizes excitable membranes, so nerve and muscle fire on minimal stimulation, producing hyperactive reflexes, cramping, twitching and tetany. Option a is incorrect because depressed bowel motility belongs to hypercalcemia, where the raised membrane threshold quiets smooth muscle. Low calcium does the opposite, giving hyperactive bowel sounds, abdominal cramping and diarrhea rather than a sluggish gut. Option b is incorrect because loss of reflexes and flaccid weakness are sedation findings seen when calcium or magnesium is high. Falling calcium lowers the firing threshold instead, so reflexes become brisk rather than weak. Option d is incorrect because a shortened QT interval with bradycardia reflects excess calcium shortening the cardiac plateau phase. Hypocalcemia lengthens repolarisation instead, prolonging the QT interval and creating the substrate for torsades de pointes.

Correct Answer: Notify the provider about the digoxin therapy

Calcium potentiates the effect of digoxin on the myocardium and can precipitate serious dysrhythmia. The nurse checks digoxin status, informs the provider before infusing and keeps continuous cardiac monitoring in place throughout the infusion. Option a is incorrect because a thiazide conserves calcium and is actually the preferred diuretic when a client is hypocalcemic. Withholding it offers no protection and does nothing about the interaction that threatens this client. Option b is incorrect because gluconate is the peripherally tolerated salt, unlike calcium chloride, which causes necrosis on extravasation. Site vigilance still matters during the infusion, but vein size is not the question to settle first. Option c is incorrect because albumin explains a misleading total calcium, and this client already has confirmed symptoms requiring treatment. Rechecking that protein now would delay an infusion the client needs while ignoring the digoxin risk.

Correct Answer: Record intake and output hourly

Measuring and recording intake and output is a routine task with a predictable outcome and no nursing judgement, so it fits within the scope of assistive personnel. The nurse keeps the assessment, teaching and feeding decisions. Option a is incorrect because changing the amount of free water given with a feeding alters the treatment itself. Decisions about fluid volume rest with the nurse and the provider, not with unlicensed staff. Option b is incorrect because judging orientation is a neurological assessment, and level of consciousness is the main gauge of how the brain is tolerating this sodium. Assessment cannot be handed off. Option d is incorrect because client and family education requires the nurse to assess understanding and adapt the content. Teaching is a licensed responsibility even when the information sounds simple to repeat.

Correct Answer: The potassium will have fallen sharply

Insulin drives potassium into cells and correcting the acidosis removes the shift that was holding potassium in the serum. Total body potassium was already depleted, so the level drops quickly. Option a is incorrect because the forces raising potassium have both been removed. Insulin is now pushing potassium inward, and the retreating acidemia no longer pulls it out of cells. Option c is incorrect because a stable value would be unexpected during active treatment. Osmotic diuresis has drained the body's stores for days, and the serum level was masking that deficit. Option d is incorrect because it reverses the direction of the exchange. As bicarbonate recovers and hydrogen leaves the cells, potassium travels inward with it, lowering rather than raising the serum value.

Correct Answer: Weight gain measured on a daily scale

Weight measures the retained fluid directly, since a kilogram gained equals about a liter held. Intake records, blood pressure and oxygen saturation all measure compensation or are recorded incompletely. Option b is incorrect because pressure readings reflect how well the client is compensating, not how much fluid is present. A client on a beta blocker or with stiff vessels can mislead the nurse completely. Option c is incorrect because totals on the intake sheet miss insensible loss through skin and breath, and depend on every staff member recording every cup. Intake alone is therefore an unreliable measure of fluid status. Option d is incorrect because desaturation appears only after fluid has already collected in the alveoli, making it a late indicator. By then the client has been accumulating volume for hours or days.

Correct Answer: Parathyroid hormone rises when serum calcium drops

The parathyroid glands sense ionized calcium and respond by negative feedback, so the two move in opposite directions. A calcium of 7.8 mg/dL drives parathyroid hormone up, and that hormone then works to raise calcium. Option a is incorrect because a direct relationship would mean the gland secretes more hormone as calcium climbs, which would push calcium higher still. Course notes that call this link direct state it backwards. Option b is incorrect because suppressing the hormone during a calcium shortage would leave the body with no way to withdraw mineral from bone. Secretion is switched off only when calcium is already high. Option c is incorrect because the thyroid C cells secrete calcitonin, the hormone released when calcium is high. Parathyroid hormone comes from four separate glands lying on the back of the thyroid.

Correct Answer: Flat jugular veins that have collapsed

Losing fluid through vomiting and diarrhea shrinks circulating volume, so the jugular venous column collapses and the neck veins appear flat. Distended neck veins would instead point to fluid volume excess. Option a is incorrect because distension reflects a loaded venous side, seen in hypervolemia and heart failure. This client has lost extracellular fluid, so the venous column falls rather than rising in the neck. Option b is incorrect because a carotid thrill is a palpable vibration from turbulent arterial flow, usually from stenosis or a bruit. Volume depletion weakens arterial pulsation and would not create that finding. Option d is incorrect because bounding pulsation belongs with fluid overload, where extra volume in a fixed space raises pressure. A client dry from three days of gastrointestinal loss has a weak, thready pulse instead.

Correct Answer: The bicarbonate, normally 22 to 26

Bicarbonate is the base measured on the gas, normally 22 to 26 milliequivalents per liter. The kidneys reabsorb, regenerate or excrete it, which is why renal compensation takes hours to days. Option a is incorrect because PaCO2 is the acid rather than the base, and the lungs control it by changing ventilation within seconds. Its normal band of 35 to 45 belongs to carbon dioxide. Option c is incorrect because PaO2 reports dissolved oxygen and answers the oxygenation question, which is read separately at step four. It plays no part in naming an acid-base disturbance. Option d is incorrect because SaO2 states the percentage of hemoglobin carrying oxygen. Saturation above 95 percent is expected, yet it tells the nurse nothing about hydrogen ion balance.

Correct Answer: Water is pulled out of brain cells

Hypernatremia makes the extracellular fluid hypertonic, so water moves out of neurons and they shrink away from their attachments. That shrinkage, not swelling, causes the irritability, twitching and seizures seen at very high sodium levels. Option b is incorrect because water floods into neurons when the sodium is low, not high. Reversing the direction of the shift also reverses the whole clinical picture, since swelling belongs to hyponatremia. Option c is incorrect because sodium is held outside the cell by the sodium potassium pump and does not stream inward. The damage comes from the osmotic movement of water, not from sodium entering neurons. Option d is incorrect because cerebral edema is the complication of lowering a high sodium too quickly, rather than a feature of the disorder itself. Correcting slowly is what protects this client from brain swelling.

Correct Answer: Metabolic acidosis that is partially compensated

The pH is acidemic and the low bicarbonate explains it, so the disorder is metabolic. The low carbon dioxide is the lungs blowing off acid, and the pH is still abnormal. Option a is incorrect because an uncompensated label demands a carbon dioxide still inside 35 to 45. Here it has already fallen, which is the respiratory system working within minutes. Option b is incorrect because alkalosis requires a pH above the midpoint, and this client is frankly acidemic. The rapid breathing is compensation for ketoacid production, not a primary respiratory problem. Option d is incorrect because respiratory acidosis requires a raised carbon dioxide. This client's carbon dioxide is low, and Kussmaul respirations are the cure rather than the disease being described.

Correct Answer: Osmotic demyelination has likely occurred

Dysarthria, dysphagia and spastic weakness appearing several days after correction of long standing hyponatremia describe osmotic demyelination syndrome. The myelin injury follows a rise the adapted brain cells could not match, and it is usually permanent. Option a is incorrect because a falling sodium swells the brain and produces headache, confusion and seizures rather than spasticity and swallowing failure. The timing after a completed correction also points away from a repeat drop. Option c is incorrect because bleeding in the brain typically declares itself abruptly with focal deficits and a falling level of consciousness. This client has a delayed, symmetric pattern that matches demyelination of the pons instead. Option d is incorrect because seizures belong to the swelling phase of untreated low sodium, not to the aftermath of raising it. Nothing in this presentation suggests cortical irritation, and the sodium has already been normalized.