The nurse has identified the problem of Fluid Volume Excess for a client with chronic renal failure.
The laboratory report indicates a serum sodium level of 120 mEq/L. The nurse interprets this finding as a:

Elevated sodium level that must be reported to the healthcare provider immediately.

Probable error in the laboratory analysis which needs to be repeated.

Expected electrolyte abnormality in clients with chronic renal failure.

Possible hemodilution effect secondary to excessive water retention.

Answer and Explanation

The Correct Answer is D

Choice A rationale

A normal serum sodium level ranges from 135 to 145 mEq/L. A value of 120 mEq/L is significantly below the normal range, indicating hyponatremia, not an elevated level. Therefore, reporting it as elevated would be incorrect.

Choice B rationale

While laboratory errors can occur, a serum sodium level of 120 mEq/L in a client with chronic renal failure is a plausible finding due to impaired fluid and electrolyte balance, making a repeat analysis not the immediate primary interpretation without further clinical context.

Choice C rationale

While electrolyte abnormalities are common in chronic renal failure, a serum sodium of 120 mEq/L is a low sodium level (hyponatremia), not necessarily an "expected" abnormality in the sense of being benign or typical without specific context. It reflects a significant imbalance.

Choice D rationale

Chronic renal failure often leads to fluid retention due to impaired kidney excretion. This excessive water retention dilutes the body's sodium concentration, leading to a condition known as dilutional hyponatremia, where the total body sodium may be normal or even elevated, but its concentration is lowered by the excess fluid.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

The nurse should recognize that the child is most likely experiencing A. Spasmodic croup as evidenced by their A. Parent’s reports.

Rationale for correct answers:
Spasmodic croup typically presents in toddlers aged 1–3 years with sudden onset of a barking, seal-like cough, often at night, without fever or signs of systemic illness. This condition is usually triggered by allergens or minor viral infections and lacks daytime respiratory distress. The child’s physical exam shows no wheezing or abnormal lung sounds, and the temperature is within normal limits (37.3°C), suggesting a non-infectious etiology like spasmodic croup rather than viral or bacterial illness.
Parent’s reports of hoarse, barking nighttime cough, normal daytime behavior, and absence of fever or appetite change are hallmark subjective cues for spasmodic croup. Objective findings during the visit are normal, so clinical suspicion relies heavily on the history provided.

Rationale for incorrect Response 1 Options:
Respiratory syncytial virus (RSV) typically presents with cough, nasal congestion, wheezing, and often respiratory distress or fever, none of which are present.
Epiglottitis presents with sudden onset of high fever, drooling, muffled voice, and severe respiratory distress, often requiring emergency airway management—not consistent with this child’s stable, playful presentation.
Acute laryngitis in toddlers is rare and typically presents with hoarseness but not the classic barking cough, and it usually follows viral upper respiratory symptoms.

Rationale for incorrect Response 2 Options:
Lung sounds are clear, so they don't support a diagnosis involving significant airway inflammation or obstruction.
Immunization history helps with disease prevention but doesn't assist in diagnosing the acute condition.
Laboratory results are normal except for mildly elevated eosinophils (780/mm³), suggesting atopy or eczema but not a direct link to the cough pattern.

Take-home points:

Spasmodic croup is often triggered by allergies or viral irritants and is characterized by nighttime barking cough in toddlers.
It should be differentiated from viral croup, RSV, and epiglottitis based on onset, symptoms, and physical findings.
Clinical history from caregivers is crucial when physical signs are minimal or absent during examination.
Absence of fever, normal labs, and clear lungs support non-infectious causes like spasmodic croup in an otherwise healthy child.

Correct Answer is ["0.5"]

Explanation

Step 1 is to convert milligrams (mg) to micrograms (mcg). 0.05 mg × 1000 mcg/mg = 50 mcg.

Step 2 is to determine the number of tablets to administer. 25 mcg ÷ (50 mcg/tablet) = 0.5 tablets. The nurse would administer 0.5 tablets.

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The nurse has identified the problem of Fluid Volume Excess for a client with chronic renal failure. The laboratory report indicates a serum sodium level of 120 mEq/L. The nurse interprets this finding as a:

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Naxlex Comprehensive Predictor Exams

A nurse is caring for an 18-month-old client in a pediatric clinic for a well-child visit and assessment of new symptoms. Complete the following sentence by using the lists of options. The nurse should recognize that the child is most likely experiencing _________ as evidenced by their ___________.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

A client is to receive Levothyroxine 25 mcg PO daily. Levothyroxine unit dose available is 0.05 mg/tablet. What would the nurse administer?

Correct Answer is ["0.5"]

Explanation

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The nurse has identified the problem of Fluid Volume Excess for a client with chronic renal failure.
The laboratory report indicates a serum sodium level of 120 mEq/L. The nurse interprets this finding as a: