NR-324 Adult Health I - Set 1 - Part 2

Correct Answer: Muscle weakness with lethargy and constipation

A calcium above 10.5 mg/dL raises the threshold that excitable tissue must reach, so the client is sedated rather than irritated. Weakness, lethargy, diminished reflexes and constipation follow, matching the BACKME pattern of hypercalcemia. Option a is incorrect because brisk gut activity belongs with a low calcium. Excess calcium slows smooth muscle, so bowel sounds become hypoactive and the client develops anorexia, nausea, abdominal pain and eventually ileus. Option b is incorrect because spasm and mouth numbness are the hallmark of a calcium deficit, not an excess. This client's membranes are harder to depolarise, so tetany and paresthesia will not appear. Option c is incorrect because reflexes fade as calcium climbs. Hyperreflexia and twitching signal a low calcium or a low magnesium, and expecting them here would lead the nurse to miss the true picture.

Correct Answer: Infusing magnesium sulfate before further calcium

Magnesium is required for parathyroid hormone release and for the tissue response to that hormone. Until magnesium is replaced the glands cannot mount a response, so the calcium stays low no matter how much is infused. Option b is incorrect because a larger dose repeats a strategy that has already failed twice and adds risk of hypotension, flushing and bradycardia. The barrier is hormonal, and more calcium does not remove it. Option c is incorrect because switching to the oral route slows delivery in a client who is already symptomatic and malnourished. Absorption still depends on hormone signalling that the magnesium deficit has disabled. Option d is incorrect because a thiazide conserves urinary calcium only modestly and would take days to matter. It also wastes magnesium, which would deepen the very deficiency keeping this calcium from correcting.

Correct Answer: Checking and replacing the serum magnesium

Intracellular magnesium plugs the ROMK channel in the distal nephron. When magnesium is depleted the channel stays open and potassium pours into the urine as fast as it is replaced, so magnesium must be repleted first. Option a is incorrect because another level will simply confirm what three failed doses already demonstrated. Waiting six more hours leaves the client at a dangerous potassium while the underlying renal leak continues unchecked. Option c is incorrect because faster infusion cannot outrun a kidney that is wasting potassium, and rapid potassium delivery risks phlebitis and lethal dysrhythmia. The problem is retention, not the speed of delivery. Option d is incorrect because oral supplementation adds another route to a body that cannot hold on to what it already receives. Alcohol use, diarrhea and a loop diuretic all point instead toward magnesium depletion.

Correct Answer: Metabolic acidosis that is fully compensated

Because the pH rests on the acid side of the midpoint, an acidosis is primary, and only a low bicarbonate produces that. The low carbon dioxide is the lungs compensating, and the pH is back in range. Option a is incorrect because an alkalosis would place the pH above the midpoint. A low carbon dioxide does cause alkalosis, but here it is the response rather than the original insult. Option b is incorrect because a partially compensated gas still shows an abnormal pH. This pH has returned inside the reference band, which upgrades the label from partial to full compensation. Option d is incorrect because a combined disorder needs both values pushing the pH the same way. Here a low bicarbonate lowers the pH while a low carbon dioxide raises it, so they oppose.

Correct Answer: Stop the magnesium sulfate infusion

Absent reflexes with respirations of ten place this client in the range where respiratory depression is next. Stopping the infusion removes the source at once, and ventilation support, provider notification and calcium gluconate follow immediately after. Option b is incorrect because the infusion keeps raising the level during every minute spent waiting for a result. Reflexes and respirations have already given the nurse the information that a laboratory number would only confirm. Option c is incorrect because giving the antidote while magnesium still flows in treats one end of the problem and ignores the other. Shut off the source, then antagonise what has already been absorbed. Option d is incorrect because position has no bearing on a reflex arc blocked at the neuromuscular junction. Rechecking wastes time the client does not have while the drug continues to suppress the respiratory drive.

Correct Answer: Support ventilation by bag-mask and give naloxone

This client has a ventilation failure, not merely an oxygen failure. Oxygen alone lifts saturation while carbon dioxide keeps climbing, so the nurse supports ventilation immediately and reverses the opioid with naloxone. Option a is incorrect because oxygen does not remove carbon dioxide. A client who is barely moving air will keep retaining it behind a comfortable saturation reading, masking a worsening respiratory arrest. Option b is incorrect because waiting for another sample wastes the only minutes this client has. The deteriorating level of consciousness and falling respiratory effort already establish what needs to be done. Option c is incorrect because sodium bicarbonate is almost always contraindicated here. Giving it generates additional carbon dioxide that a client who cannot ventilate has no way to exhale.

Correct Answer: Hold the dose and notify the provider

Anorexia, nausea and yellow tinged vision in a client whose potassium is low describe digoxin toxicity, which can occur at a normal drug level. The dose is held and the provider is notified before anything else. Option b is incorrect because giving another dose adds drug to a client whose low potassium is already increasing binding at the pump. The apical rate above sixty does not make administration safe here. Option c is incorrect because food will not settle nausea caused by a toxic drug level, and waiting lets the dysrhythmia risk grow. Visual color change is a classic warning that demands action now. Option d is incorrect because constipation is not the problem described, and a stool softener treats none of these symptoms. Halos and color vision changes point to the drug itself rather than to bowel function.

Correct Answer: Verify adequate hourly urine output

Potassium leaves the body almost entirely through the kidney, so it is not given to a client who is not making urine. The nurse confirms output of at least thirty milliliters an hour before the infusion begins. Option a is incorrect because oral intake describes what goes in and says nothing about whether the kidney can clear a potassium load. Output, not intake, is the value that governs safety for this drug. Option b is incorrect because sluggish bowel tones support the diagnosis but do not decide whether the infusion may run. Gastrointestinal findings are monitored during therapy rather than used as the gate before it. Option c is incorrect because grip testing is a useful bedside measure of muscle strength and a good way to track improvement. It does not tell the nurse whether the client can excrete the potassium given.

Correct Answer: Uncompensated respiratory alkalosis with severe hypoxemia is present

The low carbon dioxide explains the alkalemia and the bicarbonate has not moved, so the alkalosis is uncompensated. The severe hypoxemia is the urgent problem and points toward pulmonary embolism. Option a is incorrect because a markedly low oxygen level removes anxiety from consideration. Restlessness and a sense of doom are early signs of hypoxia, not proof of an emotional cause. Option b is incorrect because the bicarbonate is normal, and a metabolic alkalosis demands a bicarbonate above 26. Nothing in the history describes gastric losses that would raise it. Option d is incorrect because full compensation requires an abnormal bicarbonate and a pH back inside range. This event began minutes ago, far too fast for the kidneys to have responded.

Correct Answer: Infiltration of solution into surrounding tissue

A cool, pale, swollen site with no blood return means non vesicant solution has leaked into subcutaneous tissue. The nurse stops the infusion, removes the catheter, elevates the limb and applies a compress. Option a is incorrect because an inflamed vein is red and warm, with tenderness and a hard cord along its track. Nothing has leaked out in phlebitis, so blanching and coolness point elsewhere. Option c is incorrect because vesicant leakage produces burning pain that progresses to blistering, sloughing and necrosis over days. The description given lacks any vesicant drug and lacks the severe pain that accompanies it. Option d is incorrect because local infection shows warmth, erythema, purulent drainage and often fever rather than a cool blanched area. Swelling without blood return points to a catheter that is no longer in the vein.

Correct Answer: A high serum phosphate level

The failing kidney cannot excrete phosphate and cannot activate vitamin D, so phosphate accumulates while gut calcium absorption falls. The retained phosphate also binds circulating calcium, producing the classic low calcium with high phosphate pattern. Option a is incorrect because a low phosphate accompanies parathyroid hormone excess with a high calcium, which is the mirror of this picture. A kidney that cannot filter phosphate lets the value climb, not fall. Option b is incorrect because a chronically low calcium stimulates the parathyroid glands rather than silencing them. These clients develop secondary hyperparathyroidism, and the hormone level rises steadily as the kidney disease advances. Option c is incorrect because magnesium is cleared by the kidney, so failing renal function causes it to accumulate. Expect a rising magnesium in advanced kidney disease, particularly if magnesium containing antacids are being used.

Correct Answer: Grade three plus, moderately severe edema

A depression that lasts longer than one minute but less than two minutes is graded three plus, moderately severe pitting edema. Record the grade together with the exact site that was pressed. Option a is incorrect because two plus describes a depression that fades within ten to fifteen seconds. Ninety seconds is far beyond that window, so documenting moderate edema would understate what was found. Option c is incorrect because four plus is reserved for a depression still present after two full minutes. The pit here resolved before that point, so the most severe grade overstates the finding. Option d is incorrect because one plus means the indentation vanishes almost immediately on release. A pit visible more than a minute later reflects considerably more mobile fluid held in the interstitial tissue.

Correct Answer: Redraw the specimen for repeat testing

A potassium that does not match the client is a potassium to question. Hemolysis, a prolonged tourniquet or fist clenching during the draw falsely raises the result, so the specimen is redrawn while monitoring continues. Option a is incorrect because calcium is reserved for a client whose rhythm strip has begun to change. This monitor is clean, so stabilizing a myocardium that shows no toxicity treats a laboratory artifact. Option b is incorrect because a binder removes real potassium from the body over many hours and would drive a normal level downward. Treating a false result exposes the client to colonic injury and sodium loading. Option d is incorrect because dialysis is the definitive answer for severe hyperkalemia that resists medical therapy, not for a single odd value in someone with working kidneys. The clinical picture does not support it.

Correct Answer: Hold the order and contact the prescriber

Concentrated potassium given by push can be instantly fatal, and there is no clinical exception to the rule. The nurse holds the medication and clarifies the route with the prescriber rather than modifying the order independently. Option b is incorrect because a nurse who dilutes an unsafe route on their own has not made it safe. Potassium is never pushed, quickly or slowly, and rewriting the order at the bedside is outside the nurse's scope. Option c is incorrect because the site of the vein does not change the danger of a bolus. Central access permits a more concentrated infusion on a pump, never a push of undiluted potassium chloride. Option d is incorrect because spreading a bolus over a few minutes still floods the coronary circulation faster than myocardial cells can buffer it. Cardiac monitoring detects the arrest but does nothing to prevent it.

Correct Answer: Start an isotonic crystalloid infusion through intravenous access

Hypotension with tachycardia signals impending hypovolemic shock, so the priority is restoring circulating volume. An isotonic crystalloid such as normal saline or lactated Ringer's stays in the extracellular space and fills the vessel. Option a is incorrect because oral rehydration is preferred for mild to moderate deficit, but this client is hypotensive and still vomiting. Fluid taken by mouth cannot be absorbed quickly enough to reverse shock. Option c is incorrect because weighing is essential for tracking fluid status over days, yet it treats nothing. Standing this dizzy, hypotensive client on a scale also risks a fall before circulation is stabilized. Option d is incorrect because hypotonic fluid drives water into cells and does a poor job of filling the vessel. Hanging it in a hypotensive client can deplete circulating volume further and worsen the picture.

Correct Answer: Support ventilation and summon help immediately

A falling level of consciousness with a falling respiratory rate signals impending respiratory arrest. Ventilation must be supported now, because carbon dioxide narcosis in a retainer is a change from baseline, not the baseline. Option a is incorrect because a compensated gas describes this client when well, not when obtunded. The drowsiness and slowing breathing mark a deterioration that must be acted on now. Option b is incorrect because flooding a retainer with oxygen raises the saturation while carbon dioxide continues to climb. Oxygen is titrated to a target saturation, and it never substitutes for ventilation. Option c is incorrect because breathing exercises need an alert, cooperative client who can follow instruction. Someone difficult to rouse cannot perform them, and the delay would cost time this client lacks.

Correct Answer: It moves water into cells that have shrunk

Half normal saline is hypotonic, so water shifts from the vessel into cells that lost water when serum sodium rose. It rehydrates the cells and brings the sodium down, given slowly. Option a is incorrect because hypotonic fluid is poor at filling the vessel, since most of it leaves for the cells. An isotonic crystalloid, not this one, is what expands circulating volume reliably. Option b is incorrect because the goal here is to lower an already high sodium, not to raise it. Adding a solution with half the sodium of plasma dilutes the value rather than increasing it. Option d is incorrect because drawing water out of cells describes what hypertonic saline does, and it would worsen cellular dehydration. These cells are already shrunken and need water returned to them, not removed.

Correct Answer: Losing whole blood removes cells and plasma together

Hematocrit is a ratio of red cells to total blood volume. Suction removes plasma only, so the ratio climbs. Hemorrhage removes cells and plasma in proportion, so the ratio does not rise and later falls. Option b is incorrect because gastric drainage contains no red cells at all. It removes water, hydrogen ion, chloride and potassium, leaving the red cell mass intact within a smaller plasma volume overall. Option c is incorrect because the bleeding client's hematocrit does not climb at all. Once interstitial fluid refills the vascular space over the following hours, that value drops below where it started instead. Option d is incorrect because nothing about nasogastric drainage adds water to the plasma. Removing fluid concentrates what remains, which is why suction and vomiting both push the hematocrit upward rather than down.

Correct Answer: It reabsorbs sodium with water and excretes potassium

Aldosterone acts on the late distal tubule and collecting duct to reabsorb sodium, with water following the sodium, while potassium is excreted. Volume rises, serum sodium changes little and serum potassium falls. Option a is incorrect because water alone is the province of antidiuretic hormone from the posterior pituitary, which dilutes the plasma. Aldosterone always moves sodium first, and water accompanies it down the osmotic gradient. Option b is incorrect because dumping both sodium and water describes atrial natriuretic peptide, the body's own diuretic released when the atria stretch. That peptide directly opposes aldosterone rather than describing how it behaves. Option c is incorrect because the directions are reversed here. Sodium is the ion held back and potassium is the ion lost, which is why excess aldosterone produces hypokalemia, hypertension and metabolic alkalosis.

Correct Answer: Start the prescribed infusion of normal saline

Hypercalcemia drives polyuria, so nearly every client with a level this high is volume depleted. Isotonic saline restores circulating volume, dilutes the calcium and restores filtration so the kidney can excrete it. Volume comes first. Option a is incorrect because a loop diuretic given to a dehydrated client removes more water and pushes the calcium higher. Furosemide is adjunctive and belongs after volume has been replaced, not as the opening move. Option b is incorrect because calcitonin, although the fastest drug available, still works over hours and loses effect within about two days. It supports the saline rather than substituting for the volume this client lacks. Option d is incorrect because bisphosphonates need two to four days to suppress osteoclastic bone resorption. They are the agent of choice for malignancy, yet they cannot address the dehydration threatening this client now.