An elderly patient has been having copious vomiting for several days and has become lethargic and weak. His mucous membranes are dry.

He has poor skin turgor.

Lab work shows: sodium of 145, ABGs: pH 7.58, PCO2 38, HCO3 38, PO2 95, SO2 98. Which response best explains the patient’s lethargy and weakness?

The hypokalemia brought on severe muscle spasms, causing exhaustion.

Due to his low potassium, his cells rely on glycolysis.

Due to the hypokalemia, his cells are hyperpolarized.

The hypernatremia caused cellular dehydration, leading to lethargy.

Answer and Explanation

The Correct Answer is D

Choice A rationale
Hypokalemia can cause muscle weakness and cramps, but it does not typically lead to severe muscle spasms causing exhaustion. The patient’s symptoms of lethargy and weakness are more likely related to electrolyte imbalances and dehydration rather than muscle spasms.
Choice B rationale
While low potassium levels can affect cellular metabolism, the primary issue here is not glycolysis. The patient’s symptoms are more consistent with dehydration and electrolyte imbalances rather than a metabolic shift to glycolysis.
Choice C rationale
Hypokalemia can cause cells to become hyperpolarized, leading to muscle weakness and decreased reflexes. However, the patient’s symptoms of lethargy and weakness are more likely due to dehydration and electrolyte imbalances rather than cellular hyperpolarization.
Choice D rationale
Hypernatremia, or high sodium levels, can cause cellular dehydration, leading to symptoms such as lethargy and weakness. The patient’s lab results and clinical presentation are consistent with hypernatremia-induced cellular dehydration, which explains his symptoms.

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Correct Answer is A

Explanation

Choice A rationale
A hypertensive crisis is characterized by severely elevated blood pressure, which can cause severe headache and blurred vision due to increased intracranial pressure.
Choice B rationale
Migraines can cause severe headaches and visual disturbances, but in a patient with a history of hypertension, a hypertensive crisis is more likely.
Choice C rationale
Sinus infections can cause headaches and facial pain, but not typically blurred vision.
Choice D rationale
Gastroenteritis causes gastrointestinal symptoms like diarrhea and vomiting, not headaches and blurred vision.

A. Cerebral ischemia due to an embolus that originates in the left atrium. B. Development of ventricular fibrillation. C. Ischemia of the cerebellum due to a ruptured intracranial aneurysm. D. Prolonged capillary refill secondary to a complete lack of cardiac output.

Correct Answer is A

Explanation

Choice A rationale
Cerebral ischemia due to an embolus that originates in the left atrium is a common complication of chronic atrial fibrillation (AFib). AFib causes irregular and chaotic electrical signals in the atria, leading to poor blood flow and the formation of blood clots. These clots can travel to the brain, causing a stroke. This is the most acute and severe event associated with chronic AFib.
Choice B rationale
Development of ventricular fibrillation is a life-threatening arrhythmia that can occur in patients with severe heart disease, but it is not a common acute event in chronic AFib.
Ventricular fibrillation involves the ventricles and is characterized by rapid, erratic electrical impulses, leading to ineffective heart contractions and sudden cardiac arrest.
Choice C rationale
Ischemia of the cerebellum due to a ruptured intracranial aneurysm is not directly related to chronic AFib. While AFib increases the risk of stroke, it does not specifically cause aneurysms or cerebellar ischemia. Aneurysms are typically related to other risk factors such as hypertension and vascular abnormalities.
Choice D rationale
Prolonged capillary refill secondary to a complete lack of cardiac output is a sign of severe cardiac dysfunction or shock. While AFib can lead to heart failure and reduced cardiac output, it does not typically cause a complete lack of cardiac output. The most acute event related to AFib is the formation of emboli and subsequent stroke.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with a history of hypertension who presents with a severe headache and blurred vision. What is the most likely cause of these symptoms?

Correct Answer is A

Explanation

Which acute event is most likely to occur in a patient who has chronic atrial fibrillation?

Correct Answer is A

Explanation

A registered nurse (RN) would expect to find which sign and symptom (S&S) in the patient whose blood glucose level is 43 mg/dL?

A nurse is caring for a client with a body temperature of 38°C (100.4°F). Which of the following interventions should the nurse prioritize?

A nurse is assessing a client with a history of chronic obstructive pulmonary disease (COPD) who presents with increased shortness of breath and a productive cough. Which of the following findings would indicate a potential exacerbation of COPD?

A patient presents to his healthcare provider with complaints of severe epigastric pain. His lab work reveals high amylase and lipase levels. His diagnosis is most likely which condition?

A nurse is assessing a client with a history of chronic obstructive pulmonary disease (COPD). Which of the following findings is most concerning?

Which assessment data would indicate to the nurse that pharmacologic treatment with antibiotics and antacids has been effective for the patient diagnosed with peptic ulcer disease (PUD) secondary to H. pylori?

A nurse is assessing a client with a temperature of 39°C (102.2°F) and a blood pressure of 90/60 mmHg. Which condition is the client most likely experiencing?

A nurse is assessing a client with suspected meningitis. Which of the following symptoms would most likely indicate meningitis?