A client is admitted with dehydration and hypokalemia.
Which of the following signs and symptoms would the nurse expect to find (Select all that apply).
Muscle weakness.
Constipation.
Hyperreflexia.
Cardiac dysrhythmias.
Nausea and vomiting.
Correct Answer : A,B,D
These are all signs and symptoms of hypokalemia, which is a condition where the blood potassium level is too low. This can affect the function of the muscles, nerves, and heart. Therefore, the nurse would expect to find these signs and symptoms in a client with dehydration and hypokalemia.
Choice C is wrong because hyperreflexia is not a sign or symptom of hypokalemia.
Hyperreflexia is a condition where the reflexes are exaggerated or overactive.
This can be caused by conditions such as spinal cord injury, stroke, or electrolyte imbalances such as hypocalcemia or hypomagnesemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This is because acute renal failure is a condition where the kidneys lose their ability to filter waste and excess fluid from the blood. This can lead to fluid overload, electrolyte imbalances, and metabolic acidosis. Therefore, the nurse should monitor the patient’s urine output and fluid balance to assess the severity of the renal impairment and prevent complications.
Choice A is wrong because administering a potassium-sparing diuretic would worsen the patient’s hyperkalemia, which is a common complication of acute renal failure.
Choice B is wrong because encouraging the patient to consume a high-sodium diet would increase the patient’s fluid retention and blood pressure, which can further damage the kidneys.
Choice D is wrong because administering intravenous antibiotics is not a priority intervention for acute renal failure unless there is a specific indication of infection.
Correct Answer is C
Explanation
This is because intravenous potassium supplementation is indicated for patients with profound hypokalemia (plasma K+ <2.5 mmol/L) or cardiac arrhythmia. The rate of infusion should not exceed 10 mmol/hour to prevent complications such as hyperkalemia, cardiac arrhythmias, and phlebitis.
Choice A is wrong because monitoring urine output every 8 hours is not sufficient to prevent complications from intravenous potassium replacement therapy.
Urine output should be monitored more frequently (at least every 4 hours) to assess renal function and fluid balance.
Choice B is wrong because administering potassium via a bolus injection is dangerous and can cause fatal cardiac arrhythmias.
Potassium should never be given by intravenous push or intramuscular injection.
Choice D is wrong because encouraging the client to eat potassium-rich foods is not appropriate for patients receiving intravenous potassium replacement therapy.
Oral potassium supplementation is preferred for patients with mild to moderate hypokalemia (plasma K+ 2.5-3.5 mmol/L) who can eat and absorb oral potassium.
Potassium-rich foods include potatoes, legumes, juices, seafood, leafy greens, dairy, tomatoes and bananas.
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