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A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Suggest that the client use a salt substitute.

Advise the client to add citrus juices and bananas to her diet.

Obtain a 12-lead ECG

Obtain a blood sample for a serum sodium level

Answer and Explanation

The Correct Answer is C

Rationale:

A. Salt substitutes often contain potassium and should be avoided in clients with hyperkalemia.

B. Citrus juices and bananas are high in potassium and should be avoided in clients with hyperkalemia.

C. A 12-lead ECG may include changes such as peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration.

D. A serum sodium level should be obtained but it is not the priority in this case.

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Correct Answer is A

Explanation

Rationale:

A. Obstructive sleep apnea is a risk factor for the development of hypertension.

B. Benazepril is an antihypertensive medication and is not a risk factor for hypertension.

C. A high HDL level is a protective factor against the development of hypertension.

D. A regular exercise routine is a protective factor against the development of hypertension.

A. Diminished breath sounds B. Increased blood pressure C. Diminished heart sounds D. New systolic murmur

Correct Answer is C

Explanation

Rationale:

A. Diminished breath sounds are not typically associated with a pericardial effusion.

B. Increased blood pressure is not typically associated with a pericardial effusion but it can instead result in hypotension due to decreased cardiac output due to compression of the heart by the accumulated fluid.

C. The heart sounds may become faint or distant due to fluid accumulation around the heart.

D. A new systolic murmur may indicate a pericardial effusion and should be further evaluated.

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A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing blood pressure classifications with a group of nurses at an in-service meeting. Which of the following should the nurse include as a risk factor for the development of hypertension?

Correct Answer is A

Explanation

A nurse is caring for a client in a critical care unit who is 4 hours post operative coronary artery bypass surgery. The nurse performs the reassessment and suspects the client may be developing a pericardial effusion. What assessment findings would the nurse note in this case?

Correct Answer is C

Explanation

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