which client is at risk for hypomagnesemia

NCLEX-PN

Kaplan NCLEX Question of The Day

1. Which client is at risk for hypomagnesemia?

A. Client with a history of heart disease
B. Client taking magnesium-based antacids
C. Client with a parathyroid disorder
D. Client admitted with alcohol abuse

Correct answer: D

Rationale: The correct answer is the client admitted with alcohol abuse. Alcoholics tend to have poor nutrition due to decreased food intake, which is a common source of magnesium. Additionally, alcohol suppresses the release of ADH, leading to diuresis and magnesium loss. Choice A is incorrect because a history of heart disease does not directly increase the risk of hypomagnesemia. Choice B is incorrect as taking magnesium-based antacids would not put the client at risk for hypomagnesemia; in fact, it would help prevent it. Choice C is also incorrect as a parathyroid disorder is not typically associated with an increased risk of hypomagnesemia.

2. An RN on your unit has had an argument with the family of a client regarding the way in which the RN has changed the client's dressing. The family is adamant that the dressing change was performed incorrectly. The RN insists that sterile technique was observed. As an RN manager, what is the best response?

A. Meet with the family member and the RN to discuss the disagreement regarding the dressing change.
B. Talk to the family member and assure them that the nurse followed the hospital procedure.
C. Discuss the dressing change procedure with the RN and compare it to a current textbook.
D. Change the RN's assignment the next day to another client.

Correct answer: A

Rationale: When conflict occurs, it is best to meet with both parties together to discuss the problem. This approach allows each party to hear what the other is saying and prevents the RN manager from being caught in the middle. By facilitating a discussion between the family member and the RN, they can work together to find a resolution or the manager can mediate. This promotes open communication, understanding, and collaboration. Option A is the correct choice because it emphasizes addressing the conflict directly and seeking a mutual understanding. Option B is incorrect because just assuring the family member may not address the underlying issues. Option C is incorrect as it does not involve the family member in the resolution process. Option D is inappropriate as it doesn't address the conflict but rather avoids it by changing the RN's assignment.

3. Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in clients with hypothyroidism because:

A. it is chemically stable, nonallergenic, and can be administered orally once a day.
B. it is available in a wide range of concentrations to meet individual client requirements.
C. it is a prodrug of T3.
D. it has a long half-life.

Correct answer: A

Rationale: Levothyroxine (Synthroid) is the preferred medication for hypothyroidism due to its chemical stability, nonallergenic properties, and convenient once-daily oral administration. It is safe and effective with minimal side effects when appropriately dosed. Choice B is incorrect because while Levothyroxine is available in various concentrations, it is not the reason it is the drug of choice; the primary reason is its stability and nonallergenic nature. Choice C is wrong as Levothyroxine (T4) is not a prodrug of T3; it is converted to T3 in the body. Option D is inaccurate because Levothyroxine has a long half-life (around 7 days), enabling once-daily dosing, as opposed to a short half-life.

4. A 62-year-old female is being seen on a home visit by a nurse. The patient reports she has been taking Premarin for years. Which of the following would indicate an overdose?

A. Lower extremity edema
B. Sensory changes in the upper extremities
C. Increased occurrence of fractures
D. Decreased peripheral blood flow

Correct answer: A

Rationale: Lower extremity edema can indicate an overdose of Premarin. Premarin, an estrogen hormone replacement therapy, can cause fluid retention leading to edema in the lower extremities. Sensory changes in the upper extremities, increased occurrence of fractures, and decreased peripheral blood flow are not typically associated with an overdose of Premarin.

5. While performing wound care to a donor skin graft site, the nurse notes some scabbing at the edges and a black collection of blood. What is the nurse's next action?

A. Leave the scabbed area alone and apply extra ointment
B. Notify the physician
C. Gently remove the debris and re-dress the wound
D. Apply skin softening lotion for 3 hours and then re-dress

Correct answer: C

Rationale: When the nurse notes scabbing at the edges and a black collection of blood, it indicates the presence of debris that needs to be addressed. Leaving the scabbed area alone and applying extra ointment may not address the underlying issue and could lead to complications. Notifying the physician is important in some cases, but immediate action is required to prevent infection in this situation. Gently removing the debris and re-dressing the wound is the correct course of action to promote healing and prevent complications.