A client at risk for developing hyperkalemia states, "I love fruit and usually eat it every day, but now I can't because of my high potassium level." How should the nurse respond?
"Potatoes and avocados can be substituted for fruit."
"If you cook the fruit, the amount of potassium will be lower."
"Berries, cherries, apples, and peaches are low in potassium."
"You are correct. Fruit is very high in potassium."
The Correct Answer is C
A. "Potatoes and avocados can be substituted for fruit.": Both potatoes and avocados are actually high in potassium, so they are not suitable substitutes for the client. This response could further exacerbate the risk for hyperkalemia.
B. "If you cook the fruit, the amount of potassium will be lower.": Boiling, can slightly reduce the potassium content. However, the reduction is not substantial enough to make high-potassium fruits completely safe for someone with severe hyperkalemia,
C. "Berries, cherries, apples, and peaches are low in potassium.": Berries, cherries, apples, and peaches are indeed lower in potassium compared to many other fruits, making them a suitable option for a client at risk for hyperkalemia.
D. "You are correct. Fruit is very high in potassium.": While some fruits are high in potassium, not all fruits are, and some are low in potassium. This statement would be misleading and may unnecessarily discourage the client from eating fruit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Slices of smoked ham with potato salad: Smoked ham is high in sodium, hence inappropriate for someone on a restricted sodium diet. Potato salad, depending on preparation, can also be high in sodium due to added salt or processed ingredients.
B. Bowl of tomato soup with a grilled cheese sandwich: Both tomato soup and a grilled cheese sandwich often contain high amounts of sodium, especially if made with canned soup or processed cheese. This would not be suitable for a restricted sodium diet.
C. Salami and cheese on whole wheat crackers: Both salami and cheese are high in sodium, making this a poor choice for someone following a restricted sodium diet.
D. Grilled chicken breast with glazed carrots: Grilled chicken breast is a lean protein with minimal sodium, and glazed carrots, if prepared without added salt or high-sodium ingredients, can be a suitable option. This meal aligns with a restricted sodium diet.
Correct Answer is C
Explanation
A. Measure intake and output every 4 hours: While monitoring intake and output is important, it is not the first priority in this case. The client is exhibiting confusion due to dehydration, and immediate action is needed to correct the fluid deficit.
B. Apply oxygen by mask or nasal cannula: While oxygen may be necessary if the client shows signs of hypoxia, dehydration-induced confusion is primarily related to fluid imbalance rather than oxygenation issues. Administering fluids is the immediate priority.
C. Increase the IV flow rate to 250 mL/hr: Increasing the IV flow rate to rapidly administer fluids is the most immediate intervention to correct dehydration. Restoring fluid volume will help to resolve the confusion and address the underlying issue of dehydration.
D. Place the client in a high-Fowler's position: This position is typically used to assist with breathing or to improve respiratory function, but it does not address dehydration. Fluid resuscitation should be the first action to address confusion related to dehydration.
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