A nurse is reviewing laboratory values of a client who has severe dyspnea. Which of the following laboratory values indicates heart failure?

Brain natriuretic peptide 275 pg/mL

Calcium 9.0 mg/dL

Sodium 140 mEq/L

Potassium 4.0 mEq/L

Answer and Explanation

The Correct Answer is A

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Correct Answer is C

Explanation

The correct answer is Choice C.

Choice A rationale: Applying traction weight to the external fixator is not recommended, as it can cause excessive stress on the pins and wires, leading to complications such as infection, loosening, or breakage 1.Traction is usually applied to skeletal pins that are inserted into the bone without an external frame 2.

Choice B rationale: Monitoring the neurovascular status of the affected limb is important, but every 8 hours is not frequent enough.The nurse should perform neurovascular checks every 2 to 4 hours for the first 24 hours, then every 4 to 8 hours, according to the facility policy 3. This is to assess for signs of nerve damage, compartment syndrome, or impaired circulation, which can result from the injury or the device.

Choice C rationale: Administering pain medication 30 min prior to pin care is a correct intervention, as it can help reduce the discomfort and anxiety associated with the procedure. Pin care involves cleaning the pin sites with an antiseptic solution and applying sterile dressings to prevent infection and promote healing. The frequency and technique of pin care may vary depending on the type of device, the condition of the wound, and the facility protocol.

Choice D rationale: Adjusting the clamps on the device’s frame daily is not a nursing intervention, as it can alter the alignment and stability of the fracture. The clamps should be tightened only by the orthopedic surgeon or a trained technician, and only when necessary. The nurse should inspect the device for any loose or broken parts and report any problems to the surgeon.

So, the correct answer is Choice C, after analysing all choices.

A. Muscle weakness B. Difficulty swallowing C. Hyperreflexia D. Diarrhea

Correct Answer is A

Explanation

A potassium level of 3.2 mEq/L indicates hypokalemia, which can lead to muscle weakness. Difficulty swallowing, hyperreflexia, and diarrhoea are not typical signs of hypokalemia.

Other choices are not correct because:

B. Difficulty swallowing: Is not a typical sign of hypokalemia.

C. Hyperreflexia: Is not a typical sign of hypokalemia.

D. Diarrhea: Is not a typical sign of hypokalemia.

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A nurse is reviewing laboratory values of a client who has severe dyspnea. Which of the following laboratory values indicates heart failure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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