A nurse is collecting data from a client who is in renal failure. The nurse should identify which of the following findings is a manifestation of hyperkalemia.
Dry mucous membranes
Irregular heart rate
Hyperactive reflexes
Trousseau's sign
The Correct Answer is B
A. Incorrect. Dry mucous membranes are not typically associated with hyperkalemia.
B. Correct. Hyperkalemia can lead to cardiac dysrhythmias, including irregular heart rate.
C. Incorrect. Hyperactive reflexes are more commonly associated with hypokalemia (low potassium levels.
D. Incorrect. Trousseau's sign is a clinical indicator of hypocalcemia, not hyperkalemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Potatoes are generally considered safe for toddlers to consume, as they are usually cooked until they are soft and easy to chew.
B. Oranges can be a choking hazard if not cut into small, manageable pieces, but they are less likely to cause choking than some other foods.
C. Correct. Grapes are small and round, making them a significant choking hazard for toddlers.
They can easily become lodged in a toddler's airway.
D. Corn kernels can also be a choking hazard for toddlers, especially if they are not chewed thoroughly or if the toddler eats them directly off the cob.
Correct Answer is B
Explanation
A. Incorrect. No sounds heard after listening for 3 to 5 minutes would be considered absent bowel sounds.
B. Correct. Hyperactive bowel sounds are louder and more frequent than normal and can indicate increased bowel motility. They can also be present in early bowel obstructions due to increased peristalsis.
C. Incorrect. Soft sounds at a rate of 1/min are within the range of normal bowel sounds.
D. Incorrect. Decreased motility would result in hypoactive bowel sounds, not hyperactive.
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