A nurse is caring for a client who has a positive Trousseau's sign and bone pain. Which of the following electrolyte imbalances should the nurse suspect to find with this client?

Hyperkalemia

Hypermagnesemia

Hypocalcemia

Hyponatremia

Answer and Explanation

The Correct Answer is C

A. Hyperkalemia: Hyperkalemia involves elevated potassium levels, which can cause muscle weakness, cardiac arrhythmias, and other symptoms, but it is not associated with Trousseau's sign or bone pain.

B. Hypermagnesemia: Hypermagnesemia, an elevated magnesium level, typically causes symptoms such as muscle weakness and respiratory depression, but not Trousseau's sign or bone pain.

C. Hypocalcemia: Hypocalcemia, characterized by low calcium levels, is commonly associated with a positive Trousseau's sign (spasms induced by inflating a blood pressure cuff) and bone pain due to calcium's role in bone health and neuromuscular function.

D. Hyponatremia: Hyponatremia refers to low sodium levels, which can cause symptoms like confusion, seizures, and lethargy, but it is not related to Trousseau's sign or bone pain.

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Correct Answer is D

Explanation

A. The "Choice of Analgesia and Sedation" component of the ABCDEF assessment tool focuses on selecting appropriate pain relief and sedation strategies for the patient but does not directly relate to the weaning process.
B. "Assess, Prevent, and Manage Pain" involves ensuring the patient is comfortable and free from pain, which is important but not specifically related to weaning from the ventilator.
C. "Delirium: Assess, Prevent, and Manage" addresses the cognitive status of the patient, particularly the prevention and management of delirium, which is a critical aspect of care but not directly related to ventilator weaning.
D. "Breathing: Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT)" directly involves the weaning process, as it includes assessing the patient's ability to breathe independently by reducing or removing sedation (SAT) and evaluating their capacity for spontaneous breathing (SBT).

A. Perform needle decompression of the pleural space followed by chest tube insertion. B. Prescribe bronchodilators and schedule a pulmonary function test. C. Administer oral antibiotics and arrange follow-up in a week. D. Initiate high-flow oxygen therapy and monitor the patient.

Correct Answer is C

Explanation

A. Nasal saline irrigation alone: While nasal saline irrigation can help to clear out mucus and congestion, it is often not sufficient to treat bacterial sinusitis.

B. Oral decongestants alone: Decongestants may provide temporary relief of symptoms but are not effective against bacterial infections.

C. Oral antibiotics: Antibiotics are the most appropriate treatment for acute bacterial sinusitis, as they can target the underlying infection.

D. Intranasal corticosteroids alone: Corticosteroids can be helpful for managing allergic rhinitis but are not effective against bacterial infections.

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A nurse is caring for a client who has a positive Trousseau's sign and bone pain. Which of the following electrolyte imbalances should the nurse suspect to find with this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with weaning a client from the ventilator. Which of the following parts of the ABCDEF assessment tool does the weaning process represent?

Correct Answer is D

Explanation

Exhibits Which of the following is the most appropriate initial management for this patient?

Correct Answer is C

Explanation

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