Author Question: A nurse is documenting the electrolyte report of a client on diuretic therapy for congestive heart ... (Read 45 times)

hubes95 · **on:** Jul 17, 2018

A nurse is documenting the electrolyte report of a client on diuretic therapy for congestive heart failure. The report is as follows: sodium, 142 mEq/L; potassium, 2.5 mEq/L; calcium, 5 mEq/L; and chloride, 98 mEq/L.

Which of the following electrolyte disturbances should the nurse report to the physician? A) Hyponatremia
B) Hypochloremia
C) Hypokalemia
D) Hypocalcemia

Question 2

When measuring the blood pressure (BP) of a client with vascular disease, the nurse obtains readings of greater than a 10-point difference between both arms. This is an indication of which condition?

A) Sign of a circulatory problem
B) Arterial occlusion in the arm with the lower pressure
C) Hemorrhage or shock
D) Orthostatic hypotension

ynlevi · **Reply #1 on:** Jul 17, 2018

Answer to Question 1

C
Feedback:
The nurse should report to the physician the presence of hypokalemia in this client because the potassium level is below the normal range of 3.5 to 5.5 mEq/L. Sodium, chloride, and calcium levels in this client are within the normal range. The normal range for sodium is 135 to 145 mEq/L, chloride 95 to 105 mEq/L, and calcium 4.5 to 5.5 mEq/L.

Answer to Question 2

B
Feedback:
The nurse should take BP and pulse initially in both arms, especially for a client with vascular disease or if the reading is not within normal range. A difference of 5 to 10 points commonly exists between arms. Readings of greater than a 10-point difference indicate arterial occlusion in the arm with the lower pressure. Readings of greater than a 10-point difference between both arms do not indicate a circulatory problem, hemorrhage, shock, or orthostatic hypotension. Any pressure that is much higher than normal for the person's age (hypertension) is a sign of a circulatory problem. A very low BP (hypotension) may indicate hemorrhage or shock. When a severe drop in BP occurs, the condition is known as orthostatic hypotension.