ATI RN
Chapter 14 Nutrition and Fluid Balance Answer Key Questions
Question 1 of 5
Which of the following is NOT a sign of hyperkalemia?
Correct Answer: A
Rationale: The correct answer is A: Bradycardia. In hyperkalemia, there is increased potassium levels in the blood, leading to cardiac abnormalities. Bradycardia is not typically associated with hyperkalemia; instead, it may manifest as tachycardia or irregular heart rhythms. Hyperreflexia, muscle weakness, and tall peaked T-waves on ECG are common signs of hyperkalemia due to the effects of elevated potassium levels on nerve conduction and muscle function.
Question 2 of 5
If a patient has a serum sodium of 150 mEq/L, which fluid imbalance do they have?
Correct Answer: B
Rationale: The correct answer is B: Hypernatremia. A serum sodium level of 150 mEq/L indicates an elevated sodium concentration in the blood, which signifies hypernatremia. Hypernatremia occurs when there is an excess of sodium relative to water in the body, leading to dehydration and increased serum sodium levels. Hyponatremia (choice A) is characterized by low sodium levels, while choices C and D (Hypokalemia and Hyperkalemia) refer to imbalances in potassium levels, not sodium. Hypernatremia is the appropriate diagnosis based on the given serum sodium level.
Question 3 of 5
A patient presents with confusion, muscle cramps, and a serum potassium of 2.9 mEq/L. What is the most appropriate intervention?
Correct Answer: A
Rationale: The correct answer is A: Administer IV potassium chloride. The patient has hypokalemia (low potassium levels) which can lead to serious complications like cardiac arrhythmias. IV potassium chloride is the fastest way to increase potassium levels in severe cases. Choice B is not appropriate as oral potassium may be too slow. Choice C, calcium gluconate, is used for hyperkalemia, not hypokalemia. Choice D, sodium bicarbonate, does not address the potassium deficiency. Administering IV potassium chloride is the most appropriate and urgent intervention to quickly correct the low potassium levels and prevent further complications.
Question 4 of 5
A patient is found unconscious with a blood pH of 7.20, PaCO₂ of 50 mmHg, and HCO₃⻠of 25 mEq/L. What is the most likely cause of this condition?
Correct Answer: C
Rationale: The correct answer is C: Diabetic ketoacidosis. In DKA, the body produces excess ketones due to lack of insulin, leading to metabolic acidosis. The low blood pH (acidosis), elevated PaCO2 (due to compensatory respiratory response), and low HCO3- levels are consistent with this condition. Sedative overdose (A) would not cause metabolic acidosis. Hyperventilation (B) would lead to respiratory alkalosis, not acidosis. Excessive vomiting (D) would result in metabolic alkalosis, not acidosis. Thus, the most likely cause in this scenario is diabetic ketoacidosis.
Question 5 of 5
A patient is admitted with a serum phosphate level of 2.1 mg/dL and reports muscle weakness. Which intervention should the nurse prioritize?
Correct Answer: A
Rationale: The correct answer is A: Administer calcium supplements. In hypophosphatemia, low phosphate levels can lead to low calcium levels due to reciprocal relationship between the two minerals. This can cause muscle weakness. Administering calcium supplements helps maintain calcium-phosphate balance, improving muscle function. Administering potassium or phosphate supplements can worsen the imbalance. Encouraging sodium intake is unrelated to correcting the issue.