An athlete runs 5 miles a day. His wife notices that after he runs, he becomes lethargic and pale. He is still talking and responding appropriately. After being taken to the E.R., and having his lab work assessed, which lab value might the nurse be most concerned with?
Sodium (Na+) 125 mEq/L
Potassium (K+) 4.2 mEq/L
Calcium (Ca+) 4.8 mg/dL
Magnesium (Mg+) 2.0 mEq/L
The Correct Answer is A
Choice A reason: Sodium 125 mEq/L (normal 135-145 mEq/L) indicates hyponatremia, likely from excessive sweating during running, causing water retention or sodium loss. Low sodium disrupts cellular osmosis, leading to cerebral edema, explaining lethargy and pallor. This critical imbalance affects nerve conduction and muscle function, requiring urgent correction to prevent seizures or coma.
Choice B reason: Potassium 4.2 mEq/L (normal 3.5-5.0 mEq/L) is within normal range. Potassium regulates muscle and nerve function, including cardiac rhythm. Normal levels do not explain lethargy or pallor, as they ensure proper membrane potential and muscle contraction. In this scenario, potassium is not a concern compared to severe hyponatremia affecting neurological status.
Choice C reason: Calcium 4.8 mg/dL (normal 8.5-10.2 mg/dL) indicates hypocalcemia, which can cause muscle cramps or tetany. However, lethargy and pallor are more directly linked to hyponatremia’s neurological effects. Calcium affects muscle contraction and nerve signaling, but its impact is less acute than sodium’s role in osmotic balance and cerebral function here.
Choice D reason: Magnesium 2.0 mEq/L (normal 1.7-2.2 mEq/L) is normal. Magnesium supports muscle and nerve function, including ATP production. Normal levels do not contribute to lethargy or pallor, which are more likely due to sodium imbalance affecting brain hydration. Magnesium is not a priority concern in this acute presentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Bradycardia (pulse <60 bpm) is unlikely, as fever, infection, and pain increase sympathetic nervous system activity, elevating heart rate. Infection triggers cytokine release, and pain stimulates adrenaline, both increasing cardiac output to meet metabolic demands. Bradycardia would contradict the physiological stress response, making this incorrect for this scenario.
Choice B reason: Tachycardia (pulse >100 bpm) is likely due to fever, infection, and pain activating the sympathetic nervous system. Fever increases metabolic rate, infection induces inflammatory cytokines, and pain releases adrenaline, all elevating heart rate to enhance oxygen delivery. This physiological response matches the client’s condition, making tachycardia the correct pulse type.
Choice C reason: Dysrhythmia involves irregular heart rhythms, like atrial fibrillation, not directly caused by fever, infection, or pain. These conditions increase heart rate via sympathetic stimulation, not necessarily rhythm irregularity. Dysrhythmias require specific cardiac issues, unlike the expected tachycardia from systemic stress, making this incorrect for the client’s presentation.
Choice D reason: Bigeminal pulse (paired beats) indicates a specific arrhythmia, not typically caused by fever, infection, or pain. These conditions elevate heart rate through sympathetic activation and cytokine release, leading to tachycardia, not patterned beats. Bigeminal rhythms require cardiac-specific issues, making this an unlikely pulse type in this systemic stress scenario.
Correct Answer is D
Explanation
Choice A reason: This response dismisses the patient’s anxiety by offering superficial reassurance without addressing their emotional state. Preoperative anxiety activates the sympathetic nervous system, increasing cortisol and adrenaline, which disrupt sleep by elevating heart rate and alertness. This approach fails to validate emotions, potentially worsening stress responses and hindering psychological coping, making it non-therapeutic for addressing the patient’s distress.
Choice B reason: Questioning the patient’s insomnia and implying they should feel reassured invalidates their feelings. Anxiety triggers the hypothalamic-pituitary-adrenal axis, releasing stress hormones that disrupt REM sleep cycles. This response lacks empathy, failing to address the limbic system’s role in emotional distress, which is critical for therapeutic communication to reduce preoperative anxiety and promote emotional stability.
Choice C reason: Minimizing the patient’s concerns and focusing on pharmacological intervention ignores emotional needs. Sedatives may depress the central nervous system to induce sleep, but they don’t address anxiety-driven amygdala activation, which elevates cortisol. A therapeutic response should validate feelings and offer emotional support to mitigate stress responses, making this option inadequate for addressing the patient’s psychological state.
Choice D reason: This empathetic response acknowledges the patient’s uncertainty and invites dialogue, aligning with therapeutic communication principles. Preoperative anxiety, driven by fear of unknown surgical outcomes, activates the limbic system, increasing heart rate and cortisol. By validating emotions and offering support, this response fosters trust, reduces stress hormone release, and supports psychological coping, making it the most appropriate choice.
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