The nurse is caring for a patient with hyperkalemia. Which body system assessment is the priority?

Cardiac

Neurological

Gastrointestinal

Respiratory

Answer and Explanation

The Correct Answer is A

A. Hyperkalemia can lead to dangerous cardiac arrhythmias and other heart-related complications due to its effect on the electrical conduction system of the heart, making cardiac assessment the priority.
B. While neurological assessment is important in various conditions, it is secondary to assessing cardiac status in hyperkalemia.
C. Gastrointestinal symptoms can occur with hyperkalemia, but they do not pose an immediate life-threatening risk like cardiac issues do.
D. Respiratory assessment is essential in many contexts, but the immediate threat of hyperkalemia lies in its impact on heart function, making cardiac assessment the most critical.

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Correct Answer is A

Explanation

A. A moderate-carbohydrate diet is recommended because carbohydrates increase CO₂ production during metabolism, and limiting excessive carbohydrate intake can help manage CO₂ retention in patients with respiratory issues.
B. Low-caffeine is not directly related to CO₂ retention and does not influence carbon dioxide levels in the body.
C. High-carbohydrate intake can exacerbate CO₂ production, worsening retention issues in patients with compromised lung function.
D. High-caffeine intake is not related to CO₂ retention management and would not impact CO₂ levels in the respiratory system.

A. Nursing diagnosis B. Collaborative problem C. Defining characteristic D. Etiology

Correct Answer is D

Explanation

A. The nursing diagnosis "Impaired physical mobility" is appropriate and does not need revision.
B. There is no collaborative problem mentioned in the statement that requires revision.
C. The defining characteristic "patient's inability to ambulate" accurately reflects the patient's current condition and does not need changes.
D. The etiology "related to tibial fracture" should be revised to reflect a more precise causal factor that can be addressed by nursing interventions. A more appropriate etiology could specify the limitation in mobility rather than just stating the fracture.

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The nurse is caring for a patient with hyperkalemia. Which body system assessment is the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is experiencing carbon dioxide retention from lung problems. Which type of diet will the nurse most likely suggest for this patient?

Correct Answer is A

Explanation

The nurse is reviewing a patient's plan of care, which includes the nursing diagnostic statement, Impaired physical mobility related to tibial fracture as evidenced by patient's inability to ambulate. Which part of the diagnostic statement does the nurse need to revise?

Correct Answer is D

Explanation

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