A female patient is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and her heart "flutters" frequently. What action should the nurse take?

Correct Answer: C

Rationale: Furosemide is a potassium-wasting diuretic. A low potassium level may cause weakness and palpitations. Telling the patient to rest more often won't help the patient if she's hypokalemic. Digoxin isn't causing the patient's symptoms, so she doesn't need to stop taking it. The patient should probably avoid caffeine, but this wouldn't resolve potassium depletion.

Correct Answer: A

Rationale: Diabetes insipidus is characterized by a deficiency in antidiuretic hormone (ADH), leading to excessive urine output and thirst.

Correct Answer: B

Rationale: An air emboli is more often associated with central vein access. Usually only relatively large volumes of air administered rapidly are dangerous. It is more often a concern when air enters a central venous access line.

Correct Answer: C

Rationale: The symptoms of neck vein distention and dyspnea suggest fluid overload. Placing the patient in semi-Fowler's position and administering diuretics can help reduce fluid volume and improve breathing.

Correct Answer: A

Rationale: Signs and symptoms of hypomagnesemia are largely confined to the neuromuscular system and include confusion, tremor, tetany, laryngeal stridor, and ataxia.

Correct Answer: C

Rationale: The diuretics act on the ascending loop of Henle to prevent re-absorption of water, potassium, and sodium. Because of this, potassium and sodium levels should be monitored when a patient is receiving diuretics.

Correct Answer: D

Rationale: The symptoms of hypokalemia include GI, cardiac, renal, respiratory, and neurologic disturbances. The use of potassium-wasting diuretics, such as hydrochlorothiazide, without potassium replacement therapy is a primary cause of hypokalemia.

Correct Answer: B

Rationale: Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. The number of dissolved particles contained in a unit of fluid determines the osmolality of a solution, which influences the movement of fluid between the fluid compartments. Giving a patient who has a low blood pressure a hypertonic solution will increase the number of dissolved particles in the blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Option A is incorrect; hydrostatic pressure refers to changes in water or volume related to water pressure. Option C is incorrect; diffusion is the movement of solutes from an area of greater concentration to lesser concentration. The solutes in an intact vascular system are unable to move, so diffusion should not normally take place. Option D is incorrect; active transport is the movement of molecules against the concentration gradient and requires ATP as an energy source. This process typically takes place at the cellular level and is not involved in vascular volume changes.

Correct Answer: D

Rationale: A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO3 is also low, which causes alkalosis. The bicarb is low, which causes acidosis. The pH bicarb more closely corresponds with a decrease in pH, making the metabolic component the primary problem.