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

Correct Answer: Alkalosis has shifted calcium onto albumin binding sites

Alkalosis empties hydrogen ions from albumin binding sites, so calcium binds there instead. The ionized fraction falls and membranes destabilize, producing tetany, while the total calcium stays unchanged because the calcium never left the blood. Option a is incorrect because body calcium stores sit in bone and cannot be emptied within minutes of fast breathing. Nothing has been lost here; the calcium has simply changed seats. Option b is incorrect because carpopedal spasm is a physiological event, not an emotional one. Anxiety triggered the hyperventilation, but the spasm itself comes from a fall in the free calcium fraction. Option c is incorrect because it reverses the direction. Acidosis frees calcium off protein and raises the ionized level, which relieves tetany rather than causing it. Fast breathing blows off carbon dioxide and creates alkalosis.

Correct Answer: Inflate an arm cuff above systolic for minutes

Trousseau's sign requires a blood pressure cuff inflated above systolic pressure and held for several minutes. The induced ischemia lowers an already unstable threshold, and carpopedal spasm appears with the wrist and fingers flexed. Option a is incorrect because tapping in front of the ear elicits Chvostek's sign, which produces facial twitching. It tests the same irritability but through the facial nerve, and it is the less specific of the two. Option c is incorrect because a routine blood pressure inflates and deflates in seconds, which never produces the sustained ischemia the test depends on. Comparing arms measures perfusion, not neuromuscular irritability. Option d is incorrect because neck flexion tests for meningeal irritation, watching whether the hips and knees draw up. That examination has no bearing on serum calcium or on latent tetany.

Correct Answer: The diarrhea suggests a high serum potassium

Reflexes fall in both potassium disorders, so they cannot separate them. Bowel sounds can: the gut speeds up in hyperkalemia and slows toward ileus in hypokalemia, so diarrhea points to the high potassium. Option a is incorrect because it assigns the same imbalance to two opposite gut pictures. Distention with silent bowel sounds fits a low potassium, but active diarrhea does not fit it at all. Option b is incorrect because a high potassium drives the bowel into cramping and diarrhea rather than silence. The distended client with absent sounds fits the opposite imbalance and needs the opposite treatment. Option d is incorrect because the reasoning is inverted. Ileus and distention come from smooth muscle that has been hyperpolarized and cannot contract, the hallmark of hypokalemia, not of a rising potassium.

Correct Answer: The lungs respond in minutes; kidneys need days

Ventilation changes within one to three minutes, so the lungs are already blowing off carbon dioxide on the first gas. Renal generation of new bicarbonate takes hours to days and reaches maximum near five days. Option a is incorrect because chemical buffers are dissolved throughout blood and cells, not confined to one organ. Phosphate does buffer within the tubule, but bicarbonate, protein, and hemoglobin work everywhere in seconds. Option c is incorrect because the order is reversed. Renal machinery depends on making more transporters and enzymes, which takes protein synthesis and several days, so the kidney is always the slower of the two. Option d is incorrect because buffers keep working while the organs respond; they are not a stage that must finish first. Their limited capacity blunts the pH swing but never removes the acid load.

Correct Answer: Slow your breathing with a counted diaphragmatic pattern

Slowing the rate lets carbon dioxide rise back into range, which restores the ionized calcium and ends the tingling and spasm. A counted diaphragmatic pattern gives the client a technique to use independently. Option a is incorrect because rebreathing has been abandoned as unsafe. It drops arterial oxygen substantially in some people while often failing to raise carbon dioxide, and it has masked hypoxemia and cardiac events. Option b is incorrect because the total calcium in this client's blood is normal throughout the episode. Only the free fraction shifts, and it returns on its own once the breathing pattern is corrected. Option c is incorrect because breath holding is neither sustainable nor safe for someone already frightened and light-headed. Syncope is a genuine risk during these episodes, and a paced, controlled rhythm works far better.

Correct Answer: Rouse the client and position upright to breathe

This is a breathing problem, so the nurse acts on ventilation immediately. Rousing the client restores respiratory drive, and sitting upright drops the diaphragm and increases tidal volume, both of which lower carbon dioxide at once. Option b is incorrect because another gas an hour from now measures a deterioration the nurse can already see. Waiting for a number delays the ventilation this client needs in the next few minutes. Option c is incorrect because more opioid deepens the very sedation that is suppressing the respiratory drive. Comfort is not the problem here, and increasing the dose would push the carbon dioxide higher still. Option d is incorrect because charting a worsening level of consciousness without intervening leaves the client unventilated. Documentation follows action; a client who cannot be roused on opioids needs stimulation, oxygen, and naloxone at hand.

Correct Answer: A baked potato with the skin

A medium baked potato supplies over six hundred milligrams of potassium, more than a banana, making it one of the richest ordinary food sources for a client losing potassium through a thiazide. Option a is incorrect because white rice is a refined starch with very little potassium left after milling. Recommending it would leave the diuretic's ongoing renal potassium loss completely unreplaced. Option b is incorrect because bread is watched in this population for its sodium content rather than its potassium, and a single slice contributes a negligible amount toward the daily potassium requirement. Option c is incorrect because apple juice sits at the bottom of the fruit juice list for potassium. Orange juice delivers several times as much per cup and would be the better choice.

Correct Answer: Retaining bicarbonate and excreting hydrogen ion

The lungs are the failing system, so the kidney compensates. It reclaims and generates bicarbonate and dumps hydrogen ion in the urine, rebuilding the ratio that holds the pH inside its range despite a high carbon dioxide. Option a is incorrect because dumping base would drive the pH lower still in a client already retaining acid. Bicarbonate excretion is the renal answer to an alkalosis, not to years of carbon dioxide retention. Option c is incorrect because it describes the lungs rather than the kidney, and it describes them moving the wrong way. A client who cannot clear carbon dioxide will not fix the problem by ventilating less. Option d is incorrect because no organ manufactures carbonic acid as a therapy. Carbonic acid forms spontaneously when carbon dioxide meets water, and this client already has far too much of it in the blood.

Correct Answer: Oxygen therapy will also correct any acid-base disorder present

Oxygen corrects hypoxemia and nothing else. It cannot lower a carbon dioxide, which only improved ventilation does, and it does nothing for a metabolic disorder, which is corrected by treating the underlying cause. Option b is incorrect because the graduate has drawn the right line. Arterial oxygen and saturation report gas transfer and carrying capacity, while the carbon dioxide is the only value that reflects air movement. Option c is incorrect because that plan is exactly right for a hypoxemic client. Applying oxygen and then reassessing the response treats the abnormality on this report and needs no correction from the preceptor. Option d is incorrect because a saturation at or below ninety percent does signal inadequate delivery. Below that point the dissociation curve falls steeply, so small further drops cost a great deal of oxygen.

Correct Answer: Stop the infusion and remove the catheter

Redness, warmth and tenderness along the vein during a potassium infusion is phlebitis from a strong irritant. Stopping the infusion and removing the catheter halts the injury before the vessel is damaged further. Option a is incorrect because heat is comfort care applied after the catheter is out. Warming the area while irritant fluid keeps running leaves the vein under continuous chemical injury. Option b is incorrect because a slower rate still delivers potassium into an inflamed vessel. Reducing the rate helps prevent phlebitis before it starts; once the vein is inflamed the infusion has to stop. Option d is incorrect because flushing pushes more fluid through a vein that is already inflamed. A flush is used to check patency in a quiet site, and it will only increase this client's pain.