A) Dysphagia: While dysphagia (difficulty swallowing) can occur in individuals with long-term alcohol use, especially if there is coexisting neurological damage or esophageal disorders, it is not specifically associated with vomiting and diarrhea in the context of this scenario. The primary concern here involves electrolyte imbalances.

B) Hypoactive deep tendon reflexes (DTR): Hypoactive DTRs are typically associated with hypermagnesemia rather than hypomagnesemia. In this case, the client's condition is more likely to lead to electrolyte deficiencies, including hypomagnesemia, due to vomiting, diarrhea, and poor nutritional intake.

C) Hypomagnesemia: Chronic alcohol use often results in nutritional deficiencies, and vomiting and diarrhea can further exacerbate this by depleting electrolytes. Hypomagnesemia is a common finding in long-term alcoholics due to poor dietary intake, gastrointestinal losses, and renal losses. This can lead to symptoms such as muscle weakness, tremors, and altered mental status. Hypomagnesemia is particularly concerning because it can affect cardiovascular stability and neuromuscular function.

D) Positive Chvostek sign: A positive Chvostek sign is indicative of hypocalcemia, which can occur secondary to hypomagnesemia. However, it is not as directly associated with chronic alcoholism as hypomagnesemia itself. The positive Chvostek sign involves a facial muscle spasm in response to tapping the facial nerve and indicates neuromuscular irritability due to low calcium levels. While related, the primary electrolyte imbalance expected here is hypomagnesemia.

A) Blood pressure 178/90 mm Hg: Elevated blood pressure is more commonly associated with fluid overload or hypertension rather than dehydration. In dehydration, one would expect to see a decrease in blood pressure, particularly orthostatic hypotension, due to a reduction in blood volume.

B) Edema: Edema indicates fluid retention in the tissues, which is a sign of fluid overload rather than dehydration. Dehydration typically results in reduced extracellular fluid volume, leading to symptoms like dry mucous membranes and poor skin turgor, rather than swelling.

C) Bounding bilateral pulses: Bounding pulses are usually seen in conditions of increased cardiac output or fluid overload, where there is an excess of fluid volume. In contrast, dehydration often leads to weak and thready pulses due to decreased circulatory volume.

D) Increased urine specific gravity: Increased urine specific gravity is a direct indicator of dehydration. It occurs because the kidneys concentrate urine to conserve water, leading to a higher concentration of solutes in the urine. This is a reliable clinical marker of reduced hydration status, reflecting the body's attempt to maintain fluid balance by conserving water.

A) Cooked carrots: While cooked carrots do contain some potassium, they are not as rich in potassium as other foods. They are a good source of vitamins and nutrients, but not the most effective option for replenishing potassium levels.

B) Cheddar cheese: Cheese generally contains minimal potassium compared to other foods. It is a good source of calcium and protein, but it is not a significant source of potassium. Individuals on loop diuretics like furosemide, which can cause potassium loss, need to consume foods higher in potassium.

C) Baked potato: Baked potatoes are an excellent source of potassium. A medium-sized baked potato with the skin can provide a significant amount of potassium, which is essential for maintaining normal heart function and muscle contraction. This makes it an ideal food choice for clients on diuretics like furosemide, which can deplete potassium levels.

D) 2% milk: While milk contains potassium, it is not as high in potassium as other foods, like fruits and vegetables. Although it can contribute to daily potassium intake, it is not the most potent source for clients needing to increase their potassium levels due to diuretic use.

A) The first 2 min: While it is essential to monitor the client closely during the first few minutes of a PRBC infusion, a two-minute observation period is insufficient to detect most acute transfusion reactions. Many reactions, such as fever, chills, and allergic responses, can take longer to manifest.

B) The final 15 min: Monitoring during the final 15 minutes is important to ensure the infusion is completed without complications. However, the most critical time for monitoring is at the beginning of the infusion, as acute reactions are more likely to occur early on.

C) The first 15 min: The first 15 minutes of a PRBC transfusion are crucial because most acute transfusion reactions, such as allergic reactions, febrile non-hemolytic reactions, and hemolytic reactions, occur within this time frame. The nurse should remain at the bedside to promptly identify and manage any adverse reactions, ensuring the client's safety.

D) The final 2 min: Monitoring during the final two minutes of the infusion is also important, but it is not the critical time frame for detecting most transfusion reactions. Observing the client closely during the initial phase of the transfusion is essential to address any immediate complications.

A) Extreme thirst: While extreme thirst can be associated with electrolyte imbalances, particularly in conditions of dehydration or hypernatremia (elevated sodium levels), a sodium level of 116 mEq/L indicates hyponatremia (low sodium levels). Extreme thirst is less typical for hyponatremia.

B) Paresthesias: Paresthesias, or abnormal sensations like tingling or numbness, are more commonly associated with conditions of low calcium or potassium levels rather than sodium. In hyponatremia, neurological symptoms can occur, but they typically include lethargy or confusion rather than specific paresthesias.

C) Lethargy: Lethargy is a common symptom of severe hyponatremia. Low sodium levels can lead to cerebral edema and neurological disturbances, resulting in symptoms such as lethargy, confusion, and even seizures. This is a direct consequence of the altered osmotic balance affecting brain function.

D) Blood clots: Hyponatremia is not typically associated with an increased risk of blood clots. Blood clots are more related to conditions affecting coagulation factors, which are not directly influenced by sodium levels.

A) Isotonic solution: Isotonic solutions, such as 0.9% sodium chloride, are used to maintain fluid balance and are not ideal for treating hypernatremia. They do not correct the elevated sodium levels and might even contribute to fluid overload.

B) Total Parenteral Nutrition (TPN): TPN is a form of nutrition provided intravenously and is not specifically used to manage electrolyte imbalances like hypernatremia. It is used for clients who cannot eat or absorb nutrients through the gastrointestinal tract.

C) Hypertonic solution: Hypertonic solutions, such as 3% sodium chloride, are used to treat hyponatremia or other conditions requiring increased sodium concentration. They would exacerbate hypernatremia rather than treat it.

D) Hypotonic solution: Hypotonic solutions, such as 0.45% sodium chloride (half-normal saline) or dextrose 5% in water (D5W), are appropriate for treating hypernatremia. These solutions help dilute the excess sodium in the blood, reduce serum sodium levels, and facilitate a gradual correction of the imbalance.

A) Isotonic solution: Isotonic solutions, such as 0.9% sodium chloride, maintain the current sodium levels and fluid balance but do not correct hypernatremia. They are not suitable for lowering elevated sodium levels.

B) Total Parenteral Nutrition (TPN): TPN is used for providing comprehensive nutritional support and does not address electrolyte imbalances such as hypernatremia. It is not used to manage sodium levels directly.

C) Hypertonic solution: Hypertonic solutions, such as 3% sodium chloride, increase sodium levels and are used for treating hyponatremia or specific conditions requiring higher sodium concentrations. They would worsen hypernatremia.

D) Hypotonic solution: Hypotonic solutions, like 0.45% sodium chloride (half-normal saline) or Dextrose 5% in water (D5W), are appropriate for treating hypernatremia. They help dilute the sodium concentration in the blood and aid in correcting the elevated sodium levels

A) They must also take a vitamin D supplement: Calcium absorption is highly dependent on vitamin D, which facilitates the absorption of calcium in the intestines. Taking a vitamin D supplement alongside calcium ensures effective utilization of calcium, improving bone health and preventing deficiencies.

B) Reduce sodium intake: While reducing sodium intake can benefit overall health and reduce fluid retention, it is not directly related to the absorption of calcium supplements. The focus should be on ensuring adequate vitamin D levels for proper calcium absorption.

C) Decrease the amount of fiber in your diet: High fiber diets do not necessarily hinder calcium absorption to a significant extent. In fact, maintaining a balanced diet with adequate fiber is important for overall health. Fiber does not need to be reduced specifically for better calcium absorption.

D) Take the medication with orange juice to increase absorption: Orange juice is high in vitamin C, which does not significantly impact calcium absorption. Calcium supplements are best taken with vitamin D or with meals to enhance absorption, rather than with orange juice alone.

A) Edema: Fluid volume overload often leads to edema due to the excess fluid leaking out of the blood vessels into the interstitial spaces. This swelling is commonly observed in areas such as the ankles, legs, and hands.

B) Oliguria: Oliguria, or reduced urine output, is more indicative of fluid volume deficit or kidney dysfunction rather than overload. In fluid volume overload, the kidneys typically produce more urine to try to balance the excess fluid.

C) Hypotension: Fluid volume overload usually causes an increase in blood pressure rather than hypotension. Hypotension is more commonly associated with fluid volume deficit or severe fluid loss.

D) Hyperthermia: Hyperthermia is not a direct result of fluid volume overload. It is more related to conditions involving fever or infection. Fluid overload primarily affects fluid distribution and does not directly cause an increase in body temperature

A) The client's daily calorie intake: While daily calorie intake is important for understanding a client's nutritional needs and managing their diet, it is not required for calculating BMI. BMI calculation focuses on weight and height rather than caloric intake.

B) The client's waist circumference: Waist circumference is useful for assessing abdominal fat distribution and risk of obesity-related conditions, but it is not needed for calculating BMI. BMI calculation requires height and weight, not waist measurements.

C) The client's height: To calculate BMI, the client's height is essential. BMI is determined by dividing weight in kilograms by the square of height in meters (kg/m²). Accurate height measurement is crucial for this calculation.

D) The client's skinfold thickness: Skinfold thickness measurements are used to estimate body fat percentage but are not required for calculating BMI. BMI relies solely on weight and height, not body fat estimates.