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HESI LPN · HESI LPN Fundamentals of Nursing · HESI Chapter 14 Nutrition and Fluid Balance Answer Key

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Showing all 5 practice questions with expert explanatory rationales.

Question 1 of 5

The nurse is caring for a patient with a potassium level of 2.9 mEq/L. The nurse should carefully monitor the patient for which potential problem?

A. Excessive urinary output

B. Abdominal distention

C. Increased reflexes

D. Hyperactive bowel sounds

Expert Explanatory Rationale

Correct Answer: Abdominal distention

Question 2 of 5

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?

A. Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness.

B. Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function.

C. I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly.

D. The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving.

Expert Explanatory Rationale

Correct Answer: Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness.

Question 3 of 5

A nurse measures a patients 24-hour fluid intake and documents the findings. To be an accurate indicator of fluid status, what must the nurse also do with the information?

A. Compare the patients intake with the normal range of adult fluid intake.

B. Report the exact milliliter of intake to the physicians office nurse.

C. Compare the total intake and output of fluids for the 24 hours.

D. Ensure that the information is included in the verbal end-of-shift report.

Expert Explanatory Rationale

Correct Answer: Compare the total intake and output of fluids for the 24 hours.

Question 4 of 5

The nurse is completing a history for an older patient at risk for an acidosis

A. Which questions would the nurse be sure to ask? Select all that apply. -"Do you have any problems with breathing?" -"Which drugs do you take on a daily basis?" -"Have you experienced any activity intolerance or fatigue in the past 24 hours?" -"Do you have episodes of drowsiness or decreased alertness?" -"When was your last bowel movement?" -"Over the past month have you had any dizziness or tinnitus?" Rationale: Collect data about risk factors related to the development of acidosis. Older

B. base balance, especially diuretics and aspirin. Ask about specific risk factors, such as any type of breathing problem. Also ask about headaches, behavior changes, increased drowsiness, reduced alertness, reduced attention span, lethargy, anorexia, abdominal distention, nausea or vomiting, muscle

C. Ask the patient to relate activities of the previous 24

D. Answers 3 and 5 are not common concerns with acidosis.

Expert Explanatory Rationale

Correct Answer: Which questions would the nurse be sure to ask? Select all that apply. -"Do you have any problems with breathing?" -"Which drugs do you take on a daily basis?" -"Have you experienced any activity intolerance or fatigue in the past 24 hours?" -"Do you have episodes of drowsiness or decreased alertness?" -"When was your last bowel movement?" -"Over the past month have you had any dizziness or tinnitus?" Rationale: Collect data about risk factors related to the development of acidosis. Older

Question 5 of 5

What state will the body be in if the ingestion and metabolic synthesis of a substance is less than its metabolic utilization and excretion?

A. stable balance

B. positive balance

C. negative balance

D. net balance

Expert Explanatory Rationale

Correct Answer: negative balance

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