Author Question: The nurse is assessing a client who was described during shift report as being obtunded, and finds ... (Read 27 times)

vicky · **on:** Jul 22, 2018

The nurse is assessing a client who was described during shift report as being obtunded, and finds which of the following consistent with that description?

1. Answers questions minimally and is indifferent to stimuli.
2. Disoriented to time, place, and person with auditory hallucinations.
3. Responds only to vigorous continuous stimulation.
4. Intermittent periods of impaired judgment.

Question 2

The nurse is caring for a client with an elevated serum potassium level. The physician orders administration of glucose and insulin to drive potassium into the cell.

Another nurse asks, Elevating intracellular potassium is dangerous too, isn't it? The nurse's best response would be which of the following? 1. Yes, but not as dangerous as when the level is high in the serum.
2. Potassium level is higher in the cell, and serum potassium is more dangerous.
3. Potassium isn't normally found in the cell, so it can be more easily excreted in the cell.
4. No, potassium has no effect in the cell.

anyusername12131 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

1
Rationale: The obtunded client is awake but has a flat affect with indifference to stimuli and minimal response. Questions are barely answered with the fewest words possible. Answer option 2 describes the client who is delirious. Option 3 describes the stuporous client, and option 4 describes the confused client.

Answer to Question 2

2
Rationale: Intracellular potassium is normally high, and can be accommodated more easily in the cell than in the serum. Elevated serum potassium can cause cellular excitation, of particular danger with cardiac cells.