Author Question: The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving ... (Read 116 times)

K@

  • Hero Member
  • *****
  • Posts: 608
The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction, and is NPO.
 
  Which assessment finding would be a priority for the nurse to report to the health care provider?
  a. Oral temperature of 100.1 F
  b. Serum sodium level of 138 mEq/L (138 mmol/L)
  c. Gradually decreasing level of consciousness (LOC)
  d. Weight gain of 2 pounds (1 kg) above the admission weight

Question 2

An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately?
 
  a. K+ 3.4 mEq/L (3.4 mmol/L)
  b. Ca+2 7.8 mg/dL (1.95 mmol/L)
  c. Na+ 154 mEq/L (154 mmol/L)
  d. PO4-3 4.8 mg/dL (1.55 mmol/L)



zogaridan

  • Sr. Member
  • ****
  • Posts: 328
Answer to Question 1

ANS: C
The patient's history and change in LOC could be indicative of fluid and electrolyte disturbances: extracellular fluid (ECF) excess, ECF deficit, hyponatremia, hypernatremia, hypokalemia, or metabolic alkalosis. Further diagnostic information is needed to determine the cause of the change in LOC and the appropriate interventions. The weight gain, elevated temperature, crackles, and serum sodium level also will be reported, but do not indicate a need for rapid action to avoid complications.

Answer to Question 2

ANS: C
The elevated serum sodium level is consistent with the patient's neurologic symptoms and indicates a need for immediate action to prevent further serious complications such as seizures. The potassium and calcium levels vary slightly from normal but do not require immediate action by the nurse. The phosphate level is normal.



Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question


 

Did you know?

According to the CDC, approximately 31.7% of the U.S. population has high low-density lipoprotein (LDL) or "bad cholesterol" levels.

Did you know?

There used to be a metric calendar, as well as metric clocks. The metric calendar, or "French Republican Calendar" divided the year into 12 months, but each month was divided into three 10-day weeks. Each day had 10 decimal hours. Each hour had 100 decimal minutes. Due to lack of popularity, the metric clocks and calendars were ended in 1795, three years after they had been first marketed.

Did you know?

For about 100 years, scientists thought that peptic ulcers were caused by stress, spicy food, and alcohol. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids. Now it is known that peptic ulcers are predominantly caused by Helicobacter pylori, a spiral-shaped bacterium that normally exist in the stomach.

Did you know?

In ancient Rome, many of the richer people in the population had lead-induced gout. The reason for this is unclear. Lead poisoning has also been linked to madness.

Did you know?

As many as 20% of Americans have been infected by the fungus known as Histoplasmosis. While most people are asymptomatic or only have slight symptoms, infection can progress to a rapid and potentially fatal superinfection.

For a complete list of videos, visit our video library