The home health nurse visits a client who has a serum sodium level of 123 me/L (123 mmol/L). To explore possible etiologist for this value, what question should the nurse ask the client?
"Do you drink milk or eat dairy products at each meal?"
"How much water and ice chips do you have each day?"
"What amount of your daily meals contains fresh vegetables?"
"How frequently do you eat processed or canned foods?"
The Correct Answer is B
Choice A reason: Asking about the consumption of milk or dairy products is not directly related to the client's serum sodium level. Dairy intake does not typically cause significant changes in sodium levels. Therefore, this question would not help in identifying the cause of the hyponatremia.
Choice B reason: This question is most relevant because excessive water or ice chip intake can lead to dilutional hyponatremia. Ingestion of large amounts of water can dilute the sodium concentration in the blood, resulting in a low serum sodium level. Identifying excessive fluid intake is critical in determining if this is the cause of the client's hyponatremia.
Choice C reason: Inquiring about the number of fresh vegetables in the client's diet is more related to overall nutrition rather than directly linked to sodium levels. While vegetables can be part of a healthy diet, this question would not specifically address the cause of a low serum sodium level.
Choice D reason: The frequency of consuming processed or canned foods, which are typically high in sodium, would generally be expected to increase serum sodium levels rather than decrease them. Therefore, this question does not directly address the issue of a low sodium level.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Determining if the client has a sliding scale insulin prescription is crucial. A sliding scale insulin regimen can help manage elevated blood glucose levels effectively. In the case of a capillary glucose of 365 mg/dL, prompt intervention is needed to prevent hyperglycaemia-related complications, and insulin administration is the most appropriate immediate action.
Choice B reason: Stopping the infusion until the healthcare provider is notified may not be the best immediate action. While it is essential to address the hyperglycaemia, halting the parenteral nutrition infusion can affect the client's overall nutritional and fluid balance. The focus should be on managing the glucose levels promptly.
Choice C reason: Assessing the client's urinary output for the previous 24 hours is important for monitoring overall fluid status and kidney function, but it does not directly address the immediate need to manage the elevated glucose levels.
Choice D reason: Reviewing the client's record for a history of diabetes mellitus can provide valuable information for long-term management and understanding the client's baseline glucose control. However, it is not the most urgent action in response to an acutely elevated capillary glucose level. Immediate intervention with insulin is needed to address the hyperglycaemia.
Correct Answer is C
Explanation
Choice A reason: Reporting black stools to the healthcare provider is important because black stools can indicate gastrointestinal bleeding, which is a serious complication of gastritis. This statement reflects proper understanding and does not need additional education.
Choice B reason: Consuming caffeine in moderation is advisable because excessive caffeine can irritate the stomach lining and exacerbate gastritis symptoms. This statement is correct and shows proper understanding.
Choice C reason: Drinking plenty of water with meals might seem beneficial, but it can actually dilute stomach acid and interfere with digestion, potentially worsening gastritis symptoms. Instead, it is recommended to drink water between meals to stay hydrated without impacting digestion.
Choice D reason: Avoiding ibuprofen for headaches is important because nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can irritate the stomach lining and worsen gastritis. This statement reflects proper understanding and does not need additional education.
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