A 14-year-old female student is brought to the clinic by her mother, who says the client has been using laxatives to lose weight. The client complains of feeling tired and weak and is probably experiencing what electrolyte imbalance?

Hypocalcemia

Hyperkalemia

Hypokalemia

Hypernatremia

Answer and Explanation

The Correct Answer is C

Choice A reason: Hypocalcemia, or low blood calcium, results from impaired parathyroid function or vitamin D deficiency, causing muscle cramps and tetany. Laxative abuse primarily causes potassium loss through diarrhea, not calcium. Calcium homeostasis is tightly regulated, and laxative-induced diarrhea does not significantly deplete calcium, making this an unlikely cause of the client’s symptoms.

Choice B reason: Hyperkalemia, elevated blood potassium, occurs in conditions like renal failure or excessive potassium intake. Laxative abuse leads to potassium loss via frequent bowel movements, causing hypokalemia, not hyperkalemia. High potassium can cause cardiac arrhythmias, but the client’s fatigue and weakness align more closely with low potassium levels.

Choice C reason: Hypokalemia, low blood potassium, is a common consequence of laxative abuse due to excessive fecal potassium excretion. Potassium is essential for muscle and nerve function, and its depletion causes fatigue, weakness, and potential arrhythmias. The client’s symptoms of tiredness and weakness strongly indicate hypokalemia as the primary electrolyte imbalance.

Choice D reason: Hypernatremia, high blood sodium, results from dehydration or excessive sodium intake. While laxative abuse can cause dehydration, the primary electrolyte loss is potassium, not sodium retention. Hypernatremia may cause neurological symptoms like confusion, but the client’s fatigue and weakness are more characteristic of hypokalemia than hypernatremia.

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Correct Answer is A

Explanation

Choice A reason: Homeostasis is the body’s ability to maintain stable internal conditions, including fluid and electrolyte balance. Imbalances, like hypokalemia or hypernatremia, disrupt cellular function, potentially causing arrhythmias or neurological issues. Restoring homeostasis is the priority, as it addresses the root cause, ensuring proper organ function and preventing complications.

Choice B reason: Preventing infection is important but not the priority in fluid and electrolyte imbalances. Infections may occur secondary to other conditions, but the primary concern is correcting imbalances that affect cellular and organ function. Homeostasis must be achieved first to stabilize the client’s physiological state before addressing infection risks.

Choice C reason: Promoting mobility is relevant for overall health but not the priority in fluid and electrolyte imbalances. Imbalances can cause muscle weakness or arrhythmias, but restoring electrolyte levels takes precedence to ensure safe mobility. Without homeostasis, mobility efforts may be unsafe or ineffective due to physiological instability.

Choice D reason: Enhancing nutrition supports overall recovery but is secondary to correcting fluid and electrolyte imbalances. Nutritional deficiencies may contribute to imbalances, but the immediate goal is restoring homeostasis to prevent acute complications like cardiac or neurological dysfunction. Nutrition can be addressed once the client is stabilized.

A. Have you been having swelling in your legs? B. Have you been experiencing difficulty breathing? C. Have you been experiencing chest pain? D. Have you been experiencing heart palpitations?

Correct Answer is B

Explanation

Choice A reason: Leg swelling (edema) is a symptom of heart failure due to fluid retention from poor cardiac output. However, it is less urgent than breathing difficulties, which indicate pulmonary edema, a life-threatening complication. Assessing breathing takes priority, as it directly affects oxygenation, a critical physiological need.

Choice B reason: Difficulty breathing (dyspnea) is a hallmark of heart failure, often due to pulmonary edema from fluid backup in the lungs. This compromises oxygenation, making it a life-threatening symptom requiring immediate assessment. The ABCD-E framework prioritizes breathing, making this the most critical question to evaluate heart failure severity.

Choice C reason: Chest pain may indicate angina or myocardial infarction, which can contribute to heart failure. However, it is less specific to heart failure than dyspnea, which directly signals pulmonary congestion. Breathing difficulties pose a more immediate threat, as they affect oxygenation, a priority in acute heart failure assessment.

Choice D reason: Heart palpitations may occur in heart failure due to arrhythmias but are less specific and urgent than dyspnea. Palpitations may indicate stress or other conditions, but breathing difficulties directly reflect pulmonary edema, a critical complication requiring immediate attention to ensure adequate oxygenation and prevent respiratory failure.

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A 14-year-old female student is brought to the clinic by her mother, who says the client has been using laxatives to lose weight. The client complains of feeling tired and weak and is probably experiencing what electrolyte imbalance?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a fluid and electrolyte imbalance. The nurse knows that the priority goal of taking care of this client is?

Correct Answer is A

Explanation

The nurse is assessing a client and asks which of the following questions to evaluate potential heart failure symptoms?

Correct Answer is B

Explanation

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