A nurse is caring for a patient who has nephrotic syndrome and is receiving high-dose corticosteroid therapy.
For which of the following electrolyte imbalances should the nurse monitor?
Hypokalemia.
Hypermagnesemia.
Hyperkalemia.
Hypomagnesemia.
The Correct Answer is A
Choice A rationale
High-dose corticosteroid therapy, such as with prednisone, can cause hypokalemia by increasing potassium excretion in the kidneys. These steroids mimic the action of aldosterone, which promotes sodium reabsorption and potassium excretion in the distal convoluted tubules and collecting ducts. This process leads to increased urinary loss of potassium, potentially causing a serum potassium level below the normal range of 3.5 to 5.0 mEq/L.
Choice B rationale
Hypermagnesemia is not a typical side effect of corticosteroid therapy. Corticosteroids primarily affect sodium and potassium balance. Hypermagnesemia is more commonly associated with kidney failure or excessive intake of magnesium-containing medications. The kidneys are highly efficient at excreting magnesium, so elevated levels (normal range 1.5 to 2.5 mEq/L) are rare unless renal function is compromised.
Choice C rationale
Corticosteroid therapy actually increases the excretion of potassium from the body, leading to a decrease in serum potassium levels, not an increase. The mineralocorticoid effects of these drugs cause increased activity of the sodium-potassium pump in renal tubules, leading to the exchange of potassium for sodium, resulting in increased urinary potassium loss and a risk for hypokalemia.
Choice D rationale
While some electrolyte imbalances can occur, hypomagnesemia is not a primary concern directly linked to high-dose corticosteroid therapy. Corticosteroids' main effect on electrolytes is their mineralocorticoid activity, which primarily targets sodium and potassium regulation. Hypomagnesemia is more commonly associated with conditions like chronic alcoholism, malnutrition, or gastrointestinal losses.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Obesity is defined as a BMI of 30 or greater. A BMI of 18 is significantly below this threshold. This category indicates a high level of body fat, which increases the risk for various chronic diseases such as heart disease, type 2 diabetes, and certain cancers. The patient's BMI does not fit this classification.
Choice B rationale
Overweight is defined as a BMI between 25.0 and 29.9. The patient's BMI of 18 is substantially below this range. This category indicates excess body weight relative to height but is not classified as obese. Individuals in this category are at an increased risk for health problems.
Choice C rationale
Underweight is defined as a BMI below 18.5. The patient's BMI of 18 falls directly into this category. Being underweight can be a sign of malnutrition or an underlying health issue and can lead to its own set of health problems, including weakened immune system, osteoporosis, and anemia.
Choice D rationale
Healthy weight is defined as a BMI between 18.5 and 24.9. The patient's BMI of 18 is just below this range. This category is associated with the lowest risk for weight-related health issues and is considered the standard for good health. The patient's BMI is not within this range.
Correct Answer is C
Explanation
Choice A rationale
While managing surgical pain is important for patient comfort and can prevent splinting, which may lead to atelectasis, it is not the immediate priority. The risk of respiratory complications, such as aspiration or pneumonia, is a more serious and life-threatening concern in the immediate postoperative period for this type of surgery.
Choice B rationale
Ambulating the patient early is important for preventing complications like deep vein thrombosis (DVT) and promoting recovery. However, it is not the most critical priority immediately after an open hiatal hernia repair. The immediate post-operative risk of respiratory compromise due to the location of the incision and potential for stomach compression is the nurse's primary concern.
Choice C rationale
Preventing respiratory complications is the nurse's priority. The surgical incision is high in the abdomen, near the diaphragm, which can cause pain with breathing and lead to shallow respirations and atelectasis. There is also a risk of aspiration from the surgical site or nasogastric tube. The nurse must promote deep breathing and coughing to prevent pneumonia and atelectasis.
Choice D rationale
The management of the nasogastric tube is an important aspect of care after a hiatal hernia repair, as it is used to decompress the stomach and prevent pressure on the surgical site. However, the most life-threatening complication is a respiratory compromise. While the NG tube helps prevent vomiting and aspiration, the overall priority is to ensure adequate ventilation and prevent respiratory distress.
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