A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client's lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate?

Correct Answer: A

Rationale: Rationale for Correct Answer A (Your potassium level is high, and so I need you to let me know if you feel numbness, tingling, or weakness): 1. Acknowledges the high potassium level directly. 2. Provides specific symptoms related to hyperkalemia. 3. Encourages client involvement in monitoring and reporting symptoms promptly. Summary of Incorrect Answers: B: Mentions brain function changes, which is not a primary concern with elevated potassium levels. C: Focuses on heart-related symptoms only, missing other important symptoms of hyperkalemia. D: Suggests resolving high potassium levels solely through IV fluid changes, which is not always sufficient.

Correct Answer: A

Rationale: The correct answer is A: Administer calcium gluconate IV. In severe hypermagnesemia, excess magnesium suppresses neuromuscular function, leading to diminished reflexes and respiratory depression. Calcium gluconate antagonizes the effects of hypermagnesemia and can quickly restore neuromuscular function, including respiratory drive. Prioritizing this intervention is crucial to prevent further respiratory compromise. Choice B (Initiate dialysis immediately) may be necessary for severe cases, but it is not the initial priority in managing acute symptoms. Choice C (Start an infusion of potassium chloride) is incorrect as it can worsen hypermagnesemia by further disrupting electrolyte balance. Choice D (Provide oral phosphate supplements) is not appropriate for immediate management of severe hypermagnesemia.

Correct Answer: C

Rationale: A serious infection and fever increase metabolic rate due to the body's response to illness, requiring nutritional support.

Correct Answer: C

Rationale: Low-carb diets can lead to ketosis, where the body burns fat for fuel, producing ketones.

Correct Answer: B

Rationale: Anorexia is defined as a lack of appetite, not to be confused with anorexia nervosa.