A nurse is caring for an endurance athlete admitted for altered mental status. The client drank large amounts of water during a recent long-distance running event. The client is confused, complaining of a headache, and has a full bounding pulse. The nurse develops the plan of care based on the expectation that the client's lab work will demonstrate which of the following abnormalities?

Serum potassium 5.0 mEq/L

Serum osmolality 294 mmol/kg

Serum sodium of 127 mEq/L

Serum hemoglobin 15.7 grams/dL

Answer and Explanation

The Correct Answer is C

A. Serum potassium 5.0 mEq/L: This is within the normal range for serum potassium (3.5-5.0 mEq/L). While potassium levels are important, they are not the primary concern with symptoms of confusion and a bounding pulse due to excessive water intake.
B. Serum osmolality 294 mmol/kg: This value is within the normal range for serum osmolality (275-295 mmol/kg). Elevated or normal osmolality would not be expected in a case of water intoxication, which dilutes serum electrolytes.
C. Serum sodium of 127 mEq/L: A serum sodium level of 127 mEq/L indicates hyponatremia, a condition often caused by excessive water intake that dilutes the sodium in the bloodstream. Symptoms such as confusion, headache, and a full bounding pulse are consistent with hyponatremia, making this the expected abnormality.
D. Serum hemoglobin 15.7 grams/dL: This is within the normal range for hemoglobin (12-16 grams/dL for women and 13.8-17.2 grams/dL for men). Hemoglobin levels would not be expected to change significantly due to water intoxication.

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Correct Answer is B

Explanation

A. The client with a serum phosphorus of 4.5 mg/dL that requires assistance with planning their meals: A serum phosphorus level of 4.5 mg/dL is within the normal range, and assistance with meal planning is a lower priority compared to the other situations.
B. The client with a serum magnesium of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes: This client has hypomagnesemia, which can lead to severe complications like seizures or cardiac arrhythmias. Immediate attention is necessary due to the symptoms and the critically low magnesium level.
C. The client with a serum potassium of 5.3 mEq/L and is scheduled for hemodialysis in three hours: This potassium level is slightly elevated, but the scheduled hemodialysis suggests the issue will be addressed soon.
D. The client with a serum sodium of 145 mEq/L who is complaining of a dry mouth and wants a glass of water: A serum sodium of 145 mEq/L is on the high end of normal; the client's dry mouth is concerning but not as urgent as the issues presented by the hypomagnesemia.

A. Increased cardiac output B. An increase in GI motility and absorption C. Constant snacking between meals that results in obesity D. Living alone on a fixed income

Correct Answer is D

Explanation

A. Increased cardiac output: In older adults, cardiac output typically decreases, not increases, and this has a minor impact on nutritional status.
B. An increase in GI motility and absorption: GI motility and absorption generally decrease with age, not increase, which can affect nutritional status.
C. Constant snacking between meals that results in obesity: Obesity is less common in healthy older adults compared to issues related to malnutrition or economic factors.
D. Living alone on a fixed income: This can significantly impact nutritional status due to potential financial constraints affecting food availability and quality.

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Naxlex Comprehensive Predictor Exams

After receiving the change of shift report, the nurse reviews the electronic health record for each client. What client should the nurse see first?

Correct Answer is B

Explanation

When planning nutritional interventions for a healthy 83-year-old man, the nurse recognizes what factor is most likely to affect his nutritional status?

Correct Answer is D

Explanation

Which menu choice indicates that a client understands their nurse's teaching about the best dietary sources of iron?

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