An older patient comes into the clinic complaining of watery diarrhea for several days with abdominal and muscle cramping. The nurse realizes that this patient is demonstrating which imbalance?

Hyperkalemia

Hyponatremia

Fluid volume excess

Hypernatremia

Answer and Explanation

The Correct Answer is B

Choice A: Hyperkalemia is not an imbalance that this patient is demonstrating, because this condition occurs when the blood potassium level is too high. This can happen in patients who have renal failure, acidosis, or excessive potassium intake. Hyperkalemia can cause muscle weakness, cardiac arrhythmias, and paralysis.

Choice B: Hyponatremia is an imbalance that this patient is demonstrating, because this condition occurs when the blood sodium level is too low. This can happen in patients who have watery diarrhea, which causes the loss of sodium and water from the body. Hyponatremia can cause abdominal and muscle cramping, nausea, confusion, and seizures.

Choice C: Fluid volume excess is not an imbalance that this patient is demonstrating, because this condition occurs when the body retains more ﬂuid than it excretes. This can happen in patients who have heart failure, kidney failure, or excessive ﬂuid intake. Fluid volume excess can cause edema, distended neck veins, and crackles in the lungs.

Choice D: Hypernatremia is not an imbalance that this patient is demonstrating, because this condition occurs when the blood sodium level is too high. This can happen in patients who have dehydration, diabetes insipidus, or excessive sodium intake. Hypernatremia can cause thirst, dry mucous membranes, agitation, and coma.

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Correct Answer is C

Explanation

Choice A Reason: This is incorrect because widening of the QRS complex is a sign of severe hyperkalemia, which is a high level of potassium in the blood. A normal QRS complex duration is 0.06 to 0.10 seconds. Hyperkalemia can cause depolarization and repolarization abnormalities in the cardiac cells, leading to delayed ventricular conduction and widened QRS complexes. The nurse should monitor the client's vital signs, electrocardiogram, and serum potassium level, and administer medications or dialysis as ordered.

Choice B Reason: This is incorrect because shortening of P-wave duration is not related to hyperkalemia or polystyrene sulfonate. A normal P-wave duration is 0.06 to 0.12 seconds. The P wave represents atrial depolarization and contraction. Hyperkalemia can cause ﬂatening or disappearance of the P wave, but not shortening. Polystyrene sulfonate is a medication that binds to potassium in the gastrointestinal tract and removes it from the body through feces.

Choice C Reason: This is correct because reduction of T-wave amplitude is a sign of eﬀective treatment of hyperkalemia with polystyrene sulfonate. A normal T-wave amplitude is 0.5 mV or less. The T wave represents ventricular repolarization and relaxation. Hyperkalemia can cause peaked or tented T waves, which indicate increased excitability and risk of ventricular fibrillation. Polystyrene sulfonate lowers the serum potassium level and normalizes the T wave.

Choice D Reason: This is incorrect because restoration of QRS complex amplitude is not related to hyperkalemia or polystyrene sulfonate. A normal QRS complex amplitude is 5 to 30 mm in standard leads and 10 to 20 mm in precordial leads. The QRS complex represents ventricular depolarization and contraction. Hyperkalemia does not aﬀect the QRS complex amplitude significantly, but can cause widening or merging with the T wave in severe cases. Polystyrene sulfonate does not aﬀect the QRS complex amplitude directly, but can prevent further widening or merging.

A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hyperkalemia E. Hypercalcemia

Correct Answer is D

Explanation

Choice A Reason: This is incorrect because hypokalemia is a low level of potassium in the blood, which can cause muscle cramps, weakness, fatigue, and cardiac arrhythmias. Spironolactone is a potassium-sparing diuretic that prevents the loss of potassium in the urine and increases the excretion of sodium and water. Spironolactone can cause hyperkalemia, not hypokalemia, especially if taken with other medications or supplements that increase potassium levels.

Choice B Reason: This is incorrect because hypocalcemia is a low level of calcium in the blood, which can cause tetany, seizures, and cardiac arrhythmias. Spironolactone does not aﬀect calcium levels significantly, and this result does not indicate an urgent problem for the patient.

Choice C Reason: This is incorrect because hyponatremia is a low level of sodium in the blood, which can cause confusion, seizures, and coma. Spironolactone can cause hyponatremia by increasing the excretion of sodium and water, but this result is not related to the patient's ECG changes or muscle weakness.

Choice D Reason: This is correct because hyperkalemia is a high level of potassium in the blood, which can cause muscle weakness, cardiac arrhythmias, and cardiac arrest. Spironolactone can cause hyperkalemia by preventing the loss of potassium in the urine and increasing the retention of potassium in the body. The nurse should monitor the patient's vital signs, electrocardiogram, and serum potassium level, and administer medications or dialysis as ordered.

Choice E Reason: This is incorrect because hypercalcemia is a high level of calcium in the blood, which can cause nausea, vomiting, constipation, and cardiac arrhythmias. Spironolactone does not aﬀect calcium levels significantly, and this result does not indicate an urgent problem for the patient.

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An older patient comes into the clinic complaining of watery diarrhea for several days with abdominal and muscle cramping. The nurse realizes that this patient is demonstrating which imbalance?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a serum potassium level of 5.5 mEq/L. The provider prescribes polystyrene sulfonate. If this medication is eﬀective, the nurse should expect which of the following changes on the client's ECG?

Correct Answer is C

Explanation

A patient prescribed spironolactone is demonstrating ECG changes and complaining of muscle weakness. The nurse realizes this patient is exhibiting signs of which electrolyte imbalance?

Correct Answer is D

Explanation

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