An elderly patient has been having copious vomiting for several days and has become lethargic and weak. His mucous membranes are dry. He has poor skin turgor. Lab work shows: sodium of 145, ABGs: pH 7.58, PCO2 38, HCO3 38, PO2 95, SO2 98. Which response best explains the patient’s lethargy and weakness?
The hypokalemia brought on severe muscle spasms, causing exhaustion.
Due to his low potassium, his cells rely on glycolysis.
Due to the hypokalemia, his cells are hyperpolarized.
The hypernatremia caused cellular dehydration, leading to lethargy.
The Correct Answer is D
Choice A rationale
Hypokalemia can cause muscle weakness and cramps, but it does not typically lead to severe muscle spasms causing exhaustion. The patient’s symptoms of lethargy and weakness are more likely related to electrolyte imbalances and dehydration rather than muscle spasms.
Choice B rationale
While low potassium levels can affect cellular metabolism, the primary issue here is not glycolysis. The patient’s symptoms are more consistent with dehydration and electrolyte imbalances rather than a metabolic shift to glycolysis.
Choice C rationale
Hypokalemia can cause cells to become hyperpolarized, leading to muscle weakness and decreased reflexes. However, the patient’s symptoms of lethargy and weakness are more likely due to dehydration and electrolyte imbalances rather than cellular hyperpolarization.
Choice D rationale
Hypernatremia, or high sodium levels, can cause cellular dehydration, leading to symptoms such as lethargy and weakness. The patient’s lab results and clinical presentation are consistent with hypernatremia-induced cellular dehydration, which explains his symptoms.
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Correct Answer is D
Explanation
Choice A rationale
The left extrapyramidal tract is involved in motor control, but lesions here would not cause right homonymous hemianopia or inability to move the right arm. These symptoms are more indicative of a lesion in the cerebral hemisphere.
Choice B rationale
A lesion in the right cerebral hemisphere would cause left-sided symptoms, not right-sided. The patient’s symptoms are indicative of a lesion in the left cerebral hemisphere.
Choice C rationale
The cerebellum is involved in coordination and balance, not in causing right homonymous hemianopia or inability to move the right arm. These symptoms are more indicative of a lesion in the cerebral hemisphere.
Choice D rationale
A lesion in the left cerebral hemisphere can cause right homonymous hemianopia and inability to move the right arm. This is because the left hemisphere controls the right side of the body and processes visual information from the right visual field.
Correct Answer is A
Explanation
Choice A rationale
Administering antipyretic medication as prescribed is a priority intervention for a client with a body temperature of 38°C (100.4°F). Antipyretics help reduce fever and provide comfort to the patient. They work by inhibiting the production of prostaglandins, which are involved in the fever response.
Choice B rationale
Encouraging fluid intake to prevent dehydration is also important, but it is not the priority intervention. Adequate hydration helps maintain fluid balance and supports the body’s ability to regulate temperature.
Choice C rationale
Monitoring vital signs every 4 hours is essential for assessing the patient’s condition, but it is not an intervention that directly addresses the fever. It helps track the patient’s response to treatment and detect any changes in their condition.
Choice D rationale
Applying a cooling blanket to reduce fever can be effective, but it is typically used when antipyretic medications are not sufficient or contraindicated. Cooling measures help lower body temperature through conduction and evaporation.