A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

A client with a decreased potassium level

A client with a decreased serum glucose

A client with an increased hemoglobin A1C

A client with an increased creatinine level

None

Answer and Explanation

The Correct Answer is B

Choice A Reason:

A client with a decreased potassium level is incorrect. Hypokalemia (decreased potassium level) can cause various neurological symptoms, but it doesn't directly lead to osmotic cerebral edema.

Choice B Reason:

When plasma glucose levels are rapidly lowered, an osmotic gradient develops between the brain and plasma, which can lead to cerebral edema. Brain cells pull water from the plasma, resulting in widespread edema.

Choice C Reason:

While HbA1c is an important marker of diabetes control and may indicate poor long-term management, it does not directly relate to the acute metabolic derangements (e.g., rapid osmotic shifts, severity of acidosis) that predispose to cerebral edema in DKA.

Choice D Reason:

A client with an increased creatinine level is incorrect. Elevated creatinine levels typically indicate kidney dysfunction or dehydration, but they don't directly cause osmotic cerebral edema.

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Correct Answer is D

Explanation

Choice A Reason:

Hypertension is not typically associated with heterotopic ossifications. However, it may occur in individuals with spinal cord injuries (SCI) due to autonomic dysreflexia, a condition characterized by an exaggerated sympathetic response to stimuli below the level of injury. Autonomic dysreflexia can lead to a sudden increase in blood pressure, which, if left untreated, can result in complications such as stroke or seizure. However, hypertension is not directly related to heterotopic ossifications.

Choice B Reason:

Bradycardia is also not typically associated with heterotopic ossifications. Like hypertension, bradycardia may occur in individuals with SCI due to autonomic dysreflexia. Autonomic dysreflexia can lead to a sudden increase in blood pressure and a reflex bradycardia in response to the increased sympathetic outflow. However, bradycardia is not directly related to heterotopic ossifications.

Choice C Reason:

Fecal impaction is a potential complication of spinal cord injury (SCI) due to impaired bowel function, but it is not directly related to heterotopic ossifications. SCI can disrupt normal bowel motility and result in neurogenic bowel dysfunction, leading to symptoms such as constipation, fecal impaction, and bowel obstruction. However, fecal impaction is not specific to heterotopic ossifications.

Choice D Reason:

Arthralgia is correct. Heterotopic ossifications (HO) involve the abnormal formation of bone in soft tissues around joints, muscles, tendons, or ligaments. When HO occurs around joints, it can lead to symptoms such as pain, swelling, and decreased range of motion, collectively known as arthralgia. Therefore, arthralgia is a common finding associated with heterotopic ossifications in individuals with spinal cord injuries.

A. Higher oxygen saturations of 98% to 99% B. Lower oxygen saturations of 93% to 94% C. Lower energy expenditure D. Increased lung capacity

Correct Answer is B

Explanation

Choice A Reason:

Higher oxygen saturations of 98% to 99% is inappropriate. A pneumothorax involves the presence of air in the pleural space, which can compromise lung function and gas exchange. This compromised lung function typically leads to decreased oxygenation of the blood, resulting in lower oxygen saturations rather than higher saturations.

Choice B Reason:

Lower oxygen saturations of 93% to 94% is appropriate. A pneumothorax disrupts the normal exchange of oxygen and carbon dioxide in the lungs due to partial or complete lung collapse. As a result, the affected lung is unable to adequately oxygenate the blood, leading to lower oxygen saturations, which are indicative of hypoxemia.

Choice C Reason:

Lower energy expenditure is inappropriate. Energy expenditure is not typically affected by a pneumothorax. While the discomfort and respiratory distress associated with a pneumothorax may cause the individual to limit physical activity, there is no direct impact on overall energy expenditure.

Choice D Reason:

Increased lung capacity is inappropriate. A pneumothorax results in partial or complete collapse of the affected lung, reducing lung capacity rather than increasing it. The presence of air in the pleural space creates positive pressure, which can compress the lung and decrease its ability to expand fully during inhalation.

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A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

Nursing Test Bank

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Explanation

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