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1. A nurse is caring for a client who has been diagnosed with hyperkalemia. Which of the following findings should the nurse expect?
- A. Muscle weakness
- B. Nausea
- C. Increased thirst
- D. Restlessness
Correct answer: A
Rationale: Muscle weakness is a characteristic finding in hyperkalemia. High levels of potassium can affect the normal function of muscles, leading to weakness. Nausea and increased thirst are not typically associated with hyperkalemia. Restlessness is more commonly seen in conditions such as hypoxia or anxiety, not specifically in hyperkalemia.
2. What are the complications of untreated hypertension?
- A. Heart disease and stroke
- B. Kidney failure and vision loss
- C. Pulmonary embolism and arrhythmias
- D. Blood clots and gastrointestinal bleeding
Correct answer: A
Rationale: The correct answer is A: 'Heart disease and stroke.' Untreated hypertension can lead to various complications, including heart disease and stroke. These are common outcomes of long-term high blood pressure. Choice B, 'Kidney failure and vision loss,' is incorrect as kidney failure and vision loss are more commonly associated with diabetic complications rather than untreated hypertension. Choice C, 'Pulmonary embolism and arrhythmias,' while serious, are not among the primary complications of untreated hypertension. Choice D, 'Blood clots and gastrointestinal bleeding,' are not typical complications of untreated hypertension but can occur due to other conditions such as blood clotting disorders or gastrointestinal diseases.
3. A client is receiving furosemide. Which of the following laboratory values should the nurse monitor?
- A. Sodium
- B. Potassium
- C. Calcium
- D. Magnesium
Correct answer: B
Rationale: The correct answer is B: Potassium. Furosemide is a loop diuretic that can cause potassium depletion through increased urinary excretion. Monitoring potassium levels is crucial to prevent hypokalemia, which can lead to cardiac dysrhythmias, muscle weakness, and other serious complications. Monitoring sodium, calcium, and magnesium levels is not typically associated with furosemide therapy, making choices A, C, and D incorrect.
4. A nurse is caring for a client who has returned to the medical-surgical unit following a transurethral resection of the prostate (TURP). Which of the following should the nurse identify as a priority nursing assessment after reviewing the client's information?
- A. Level of consciousness.
- B. Skin turgor.
- C. Deep-tendon reflexes.
- D. Bowel sounds.
Correct answer: A
Rationale: The correct answer is A: Level of consciousness. Following a TURP procedure, monitoring the client's level of consciousness is crucial as it can indicate potential postoperative complications such as hemorrhage or shock. Skin turgor (choice B) is more related to hydration status, deep-tendon reflexes (choice C) are not the priority post-TURP, and bowel sounds (choice D) are important but not the priority in this situation.
5. What are the key nursing interventions for a patient receiving diuretic therapy?
- A. Monitor electrolyte levels and administer potassium as needed
- B. Restrict fluid intake and provide a low-sodium diet
- C. Encourage oral fluids and increase dietary potassium
- D. Provide high-sodium foods to improve electrolyte balance
Correct answer: A
Rationale: The correct answer is A: Monitor electrolyte levels and administer potassium as needed. Patients on diuretic therapy are at risk of electrolyte imbalances, particularly low potassium levels. Monitoring electrolytes and administering potassium as needed are crucial nursing interventions to prevent imbalances. Choice B is incorrect because restricting fluid intake and providing a low-sodium diet are not typically indicated for patients on diuretic therapy. Choice C is incorrect as encouraging oral fluids and increasing dietary potassium can exacerbate electrolyte imbalances in patients on diuretics. Choice D is incorrect as providing high-sodium foods would worsen electrolyte balance issues in patients on diuretic therapy.
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