NR-226 Patient Care Fundamentals - Set 3 - Part 2

Correct Answer: I season my food with a salt substitute now.

Salt substitutes replace sodium chloride with potassium chloride and can carry thousands of milligrams of potassium per teaspoon. Added to a potassium-sparing diuretic and an ACE inhibitor, that is a recipe for hyperkalemia. Option a is incorrect because label reading is exactly what this client needs to keep doing. Many products marketed as low in sodium list potassium chloride, and the label is where that is caught. Option b is incorrect because herbs and spices add flavor without adding either sodium or potassium. Cooking this way is the substitution the nurse should be praising rather than correcting. Option c is incorrect because scheduled draws are essential on drugs that block aldosterone. Keeping those appointments is how a creeping potassium is found before the client ever feels a symptom.

Correct Answer: Tall peaked T waves with a narrow base

Repolarization fails first when potassium rises, and the T wave is ventricular repolarization, so tall narrow-based peaked T waves are the earliest tracing change. Conduction changes in the P wave and QRS follow later. Option b is incorrect because flattening and loss of the P wave come with a moderately high potassium, after the T wave has already changed. It marks atrial conduction failing, a later step. Option c is incorrect because ventricular conduction is the third system to give way. A broadening QRS signals that the client has moved from abnormal but stable toward imminent arrest, not an early warning. Option d is incorrect because the sine wave is the terminal pattern, formed when the widened QRS merges with the T wave. Ventricular fibrillation or asystole follows within moments of its appearance.

Correct Answer: Partially compensated metabolic alkalosis with retained acid

Bicarbonate is high and matches the alkalotic pH, so the primary problem is metabolic alkalosis. The raised carbon dioxide is deliberate hypoventilation holding acid in, and because the pH is still abnormal, compensation remains partial. Option a is incorrect because an uncompensated gas requires the second value to be inside its normal range. A PaCO2 of 48 is above 45, so the lungs have clearly already begun to respond. Option b is incorrect because full compensation is defined by a pH that has returned inside its normal band. This client's pH is still frankly alkalotic, which places the gas one step short of that state. Option d is incorrect because naming a respiratory acidosis would require a low pH driven by the carbon dioxide. Here the pH leans alkaline, so the high PaCO2 is following the bicarbonate, not causing the disturbance.

Correct Answer: Perform oral care and suck sugar free candy

Thirst on a restriction is managed without adding fluid. Frequent oral care, chilled swabs and sugar free hard candy moisten the mouth and stimulate saliva, relieving the sensation while the measured allowance stays intact. Option a is incorrect because soup and gelatin are counted as fluid on a restriction. Swapping one liquid for another changes nothing about the total, and the client would still be limited to the same daily volume. Option c is incorrect because hoarding the whole allowance for one part of the day leaves many waking hours with nothing at all. Dividing the total across shifts spreads relief and improves adherence to the plan. Option d is incorrect because drinking on demand defeats the entire purpose of the restriction. Extra free water dilutes the serum further, and in a client whose sodium is already low that means deepening the problem.

Correct Answer: Increasing rate and depth to blow off acid

The kidney is the failing organ here, so the lungs compensate. Increasing rate and depth clears carbon dioxide, which removes volatile acid and lifts the pH back toward normal within minutes of the imbalance. Option a is incorrect because hypoventilation holds carbon dioxide in and drives the pH down further. That response belongs to metabolic alkalosis, where retaining acid is exactly what the body needs. Option b is incorrect because the tubules are the very structures that have failed. Asking a damaged kidney to dump bicarbonate would also throw away the base this client desperately needs to buffer accumulating acid. Option c is incorrect because protein buffers accept hydrogen ion rather than release it during acidosis. They act within seconds and blunt the pH swing, but they are consumed and cannot correct the cause.

Correct Answer: Prominent U wave after the T wave

Hypokalemia delays ventricular repolarization, producing T wave flattening, ST depression, and a prominent U wave immediately after the T wave. The U wave is the classic marker taught for a low serum potassium. Option b is incorrect because tall peaked T waves belong to hyperkalemia, where excess extracellular potassium alters repolarization. They are the earliest change of a rising potassium, the mirror image of this client's problem. Option c is incorrect because a widened QRS with absent P waves marks advanced hyperkalemia, the point at which conduction is failing and arrest is near. Nothing in a low potassium produces that pattern. Option d is incorrect because the QT interval lengthens rather than shortens in hypokalemia as the T and U waves fuse. Shortening of the QT is described with hypercalcemia and early hyperkalemia.

Correct Answer: Recording daily weights and measuring oral intake

Weighing a client and measuring what is taken in are standardized tasks with predictable outcomes, which places them within the assistive role. The nurse still interprets the numbers and decides what the trend means. Option a is incorrect because client teaching requires the judgment to tailor content and check understanding. Explaining what counts toward a restriction belongs to the registered nurse, who can also answer the questions the explanation raises. Option c is incorrect because neurologic assessment is the single finding that decides urgency in a sodium disorder. A change in level of consciousness must be recognized by someone able to interpret it, which rules out unlicensed staff. Option d is incorrect because evaluating a plan is the final step of the nursing process and cannot be handed off. Deciding whether the restriction is achieving its goal requires comparing data against expected outcomes.

Correct Answer: Assess the airway and call for help

The flood of phosphate has bound calcium, and hoarseness with perioral tingling signals laryngospasm from the resulting deficit. Airway comes before every other concern, so the nurse assesses it and summons help at once. Option a is incorrect because a binder works over days by trapping phosphate in food, and the next meal is far away. It is useful therapy later and useless for a larynx that is closing now. Option b is incorrect because dietary planning addresses a long term problem while this client has an immediate one. A dietitian referral belongs in the plan of care, not in the response to airway compromise. Option c is incorrect because hydration does support renal clearance of phosphate and uric acid in this syndrome. Asking a client with laryngeal spasm to drink, however, risks aspiration and delays the rescue that matters.

Correct Answer: Drawing up the ordered dose for intravenous push

Concentrated potassium chloride given as a push or bolus is uniformly fatal, which is why it is never given by that route. Potassium must be diluted and infused slowly through a pump. Option a is incorrect because a calibrated electronic pump is required for every potassium infusion. Gravity tubing cannot guarantee the rate, so putting the bag on a pump is exactly what safe practice demands. Option b is incorrect because urine output must be verified before potassium runs. The kidney clears about ninety percent of a potassium load, so an oliguric client can be pushed into fatal hyperkalemia. Option d is incorrect because potassium is a strong vessel irritant and hourly site checks catch phlebitis or infiltration early. This is a required monitoring step rather than an error needing correction.

Correct Answer: A positive Chvostek's sign suggesting low calcium

Tapping the facial nerve in front of the ear elicits Chvostek's sign, and ipsilateral facial twitching is a positive result. It reflects the neuromuscular irritability that a calcium deficit produces. Option b is incorrect because Trousseau's sign uses a blood pressure cuff inflated above systolic pressure for several minutes and produces carpopedal spasm in the hand. No cuff was applied here. Option c is incorrect because the Homans sign involves dorsiflexing the foot and looking for calf pain in suspected deep vein thrombosis. It has nothing to do with the face or with calcium. Option d is incorrect because a Babinski response is elicited by stroking the sole of the foot and watching the great toe. Facial twitching after a tap belongs to a different assessment entirely.

Correct Answer: The lengthened interval belongs to the lower calcium

Calcium drives the plateau phase of the cardiac action potential. Too little calcium slows that phase and stretches the QT interval, bringing torsades risk, while an excess speeds it and shortens the interval. Option a is incorrect because a single calcium value cannot produce two opposite tracings. The two clients sit at opposite ends of the range, and only one of them has a deficit. Option c is incorrect because the pairing is the other way round. Shortening comes from abundant calcium racing through the plateau phase, so that tracing belongs to the client with too much. Option d is incorrect because the QT interval is one of the most direct bedside reflections of calcium status. Ignoring the tracing would discard the earliest sign that a client is heading toward torsades.

Correct Answer: Swallow each tablet whole with plenty of water

Potassium salts irritate the gastrointestinal mucosa, so the tablet is taken whole with a full glass of water or with food. Extended-release forms release the drug gradually and must not be broken open. Option b is incorrect because crushing an extended-release tablet dumps the entire dose at once onto the gastric lining. If swallowing is hard, the client needs a liquid or effervescent form, not a crushed tablet. Option c is incorrect because an empty stomach concentrates the irritant against unprotected mucosa. Food and fluid buffer the dose and reduce the nausea, cramping and bleeding risk that potassium salts can cause. Option d is incorrect because self-discontinuing replacement lets the potassium drift down again. Mild stomach upset is managed by taking the dose with food and reporting it, while severe pain or bleeding is reported promptly.

Correct Answer: Ionized calcium has fallen as pH rose

Alkalemia frees binding sites on albumin as hydrogen ion comes off, so more calcium binds to protein. The ionized fraction that stabilizes nerve membranes falls, and nerves fire easily, producing perioral tingling and carpopedal spasm. Option a is incorrect because the total calcium on the chemistry panel stays exactly where it was. Only the distribution between the bound and free fractions changes, so a dietary or parathyroid deficiency is not present. Option b is incorrect because alkalosis moves potassium into cells, not out of them, and the resulting hypokalemia shows up as weakness and flat T waves. Neither of those explains a clawed, spasming hand. Option d is incorrect because cerebral vasoconstriction from low carbon dioxide is real here, but it produces light-headedness, blurred vision, and faintness. It cannot account for muscles in the hand contracting on their own.

Correct Answer: Stop the magnesium sulfate infusion

Absent reflexes with slowed breathing mean the magnesium level has climbed into the dangerous range. Stopping the infusion halts further loading and is the one action that must precede assessment, calling and antidote. Option a is incorrect because the clinical picture already establishes toxicity, and the drug keeps infusing while the specimen travels to the laboratory. A level will be obtained, but after the source is shut off. Option b is incorrect because calcium gluconate is the correct antagonist and will be needed shortly, yet giving it while magnesium still runs in is treating against an open tap. Stop the source, then reverse. Option c is incorrect because positioning protects the airway of a drowsy client but does nothing about the drug that is depressing her. Repositioning follows once the infusion is off and help is coming.

Correct Answer: Keeping the drowsy client and delegating routine hygiene care

A client whose carbon dioxide is climbing needs continuous nursing assessment and judgment, so the registered nurse keeps that client. Bathing and other routine hygiene are standardized tasks that assistive personnel can safely perform. Option a is incorrect because an unstable client on the edge of respiratory failure requires ongoing evaluation that unlicensed staff are not prepared to provide. Handing off that surveillance leaves the deterioration unrecognized until it is severe. Option b is incorrect because oxygen is a drug with a prescribed dose. Adjusting the flow requires assessing the response, and in a client who retains carbon dioxide an uncontrolled increase can worsen the ventilation problem. Option d is incorrect because naming a disorder and its compensation is a registered nurse responsibility in this situation. The practical nurse contributes data and reinforces the plan, but the interpretation guiding priority care stays with the nurse.

Correct Answer: Hold the dose and notify the provider

Absent bowel sounds with distention after surgery point to a paralytic ileus, and oral potassium given into a gut that is not moving will not absorb and worsens irritation. Holding and reporting is correct. Option b is incorrect because water does not make a nonfunctioning bowel absorb the drug. Fluid with the dose is the right technique when peristalsis is intact, and here it plainly is not. Option c is incorrect because food is contraindicated in a client with an ileus. Adding a snack loads more volume into a bowel that already cannot move its contents, inviting vomiting and aspiration. Option d is incorrect because crushing changes only the dosage form, never the underlying problem. An extended-release product must stay intact anyway, and the route itself is what has to be reconsidered here.

Correct Answer: The serum potassium has risen toward its normal range

Alkalosis drives potassium into cells, and vomiting has already depleted body stores, so replacement is the treatment. A potassium climbing back toward its range shows the deficit is being corrected and the alkalosis can finally resolve. Option a is incorrect because brisker reflexes signal an ionized calcium that is still falling with the alkalemia. That change points toward worsening neuromuscular irritability and possible tetany, not toward a resolving imbalance. Option c is incorrect because the lungs compensate for this alkalosis by holding carbon dioxide in, so the value should be at or above its range. A falling carbon dioxide would push the pH even higher. Option d is incorrect because flattening T waves are the electrocardiographic signature of a potassium that is still too low. Seeing them deepen means the replacement has not yet caught up with the deficit.

Correct Answer: A rising serum potassium with peaked T waves

Hydrogen ion moves into cells to be buffered during acidosis, and potassium moves out to keep the charge balanced. The injured kidney cannot excrete that load, so the level climbs and T waves peak. Option a is incorrect because potassium falls in alkalosis, when hydrogen leaves the cell and potassium takes its place. Flattened T waves, ST depression, and U waves belong to that opposite picture. Option b is incorrect because sodium tracks water balance rather than pH. Kidney injury can certainly disturb sodium, but the exchange that acidosis drives across the cell membrane involves hydrogen and potassium instead. Option c is incorrect because acidemia does raise the ionized calcium fraction, yet more free calcium quiets nerve membranes instead of exciting them. Hyperactive reflexes and tetany appear when the ionized fraction falls.

Correct Answer: Hold the digoxin and notify the provider

A high calcium acts on the myocardium the same way digoxin does, so toxicity appears even at a therapeutic level. Nausea, appetite loss, yellow halos and bradycardia are the classic picture, and the drug is held. Option a is incorrect because giving another dose adds to an effect already amplified by the calcium. A slow pulse with visual disturbance is the warning to withhold, and rechecking afterwards comes far too late. Option b is incorrect because treating the nausea as a comfort problem masks the signal it carries. Appetite loss and vomiting here are systemic toxicity, and food will not resolve a drug and electrolyte interaction. Option d is incorrect because raising the dose deepens the very toxicity the client is displaying, and dose changes are prescriber decisions in any case. Rate control never justifies pushing a toxic drug further.

Correct Answer: Stay with the client and summon help

Stridor and voice change signal laryngospasm, a tetany of the laryngeal muscles that closes the airway. Airway outranks every other finding, so the nurse stays and gets help and equipment immediately. Option b is incorrect because waiting for a laboratory result delays treatment of an airway that is closing now. The calcium will be drawn, but it follows rescue rather than preceding it. Option c is incorrect because Trousseau's sign confirms latent tetany in a stable client, and this client already has visible tetany of the larynx. Inflating a cuff adds nothing and wastes minutes. Option d is incorrect because an hour of watchful waiting can end in complete airway obstruction. Documentation records what happened; it is never the intervention for a client who cannot move air.