NCLEX Secrets - Level of Cognitive Ability
6. A nurse is reviewing a client's laboratory report and notes that the serum calcium level is 4.0 mg/dL. The nurse understands that which condition most likely caused this serum calcium level?
a) prolonged bed rest
b) renal insufficiency
c) hyperparathroidism
d) excessive ingestion of vitamin D
7. A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expect to note in the client?
a) twitching
b) negative trousseau's sign
c) hypoactive bowel sounds
d) hypoactive deep tendon reflexes
8. A nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram?
a) widened T wave
b) prominent U wave
c) prolonged QT interval
d) shortened ST segment
9. A nurse caring for a client with severe malnutrition reviews the laboratory results and notes a magnesium level of 1.0 mg/dL. Which electrocardiographic change would the nurse expect to note based on the magnesium level?
a) prominent U waves
b) prolonged PR interval
c) depressed ST segment
d) widened QRS complexes
10. A nurse reviews a client's laboratory report and notes that the client's serum phosphorus level is 2.0 mg/dL. Which condition most likely caused this serum phosphorus level?
a) alcoholism
b) renal insufficiency
c) hypoparathyroidism
d) tumor lysis syndrome
NCLEX Secrets - Level of Cognitive Ability:
ANSWERS AND RATIONALE
6) A
- the normal serum calcium level is 8.6 to 10.0 mg/dL. A client with a serum calcium level of 4.0 mg/dL is experiencing hypocalcemia. The excessive ingestion of vitamin D and hyperthyroidism are causative factors associated with hypercalcemia. End-stage renal disease, rather than renal insufficiency, is a cause of hypercalcemia. Prolonged bed rest is a cause of hypocalcemia. Although immobilization initially can cause hypercalcemia, the long-term effect of prolonged bed rest is hypocalcemia.
7) A
- signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety.Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.
8) C
- electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia.
9) C
- the normal magnesium level is 1.6 to 2.6 mg/dL. A magnesium level of 1.0 mg/dL indicates hypomagnesemia. In hypomagnesemia, the nurse would note tall T waves and a depressed ST segment. Options B and D would be noted in a client experiencing hypermagnesemia. Prominent U waves occur with hypokalemia.
10) A
- the normal serum phosphorus level is 2.7 to 4.5 mg/dL. The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Malnutrition is associated with alcoholism. Hypoparathyroidism, tumor lysis syndrome, and renal insufficiency are causative factors of hyperphosphatemia.
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