Choice A reason:

Sodium is the most likely electrolyte to be elevated in a client who has fluid volume excess. This is because fluid volume excess, or hypervolemia, is caused by an increase in total body sodium content and an increase in total body water. Sodium is the main electrolyte that regulates fluid balance in the body. When sodium levels are high, the body retains water to dilute it. This leads to fluid overload and edema. Therefore, a client with fluid volume excess would have high sodium levels in their blood.

Choice B reason:

Potassium is not likely to be elevated in a client who has fluid volume excess. Potassium is mainly found inside the cells, and its levels are regulated by the kidneys. Potassium levels can be affected by acid-base balance, insulin, aldosterone, and cell damage. A client with fluid volume excess may have low potassium levels due to dilution or increased excretion by the kidneys.

Choice C reason:

Calcium is not likely to be elevated in a client who has fluid volume excess. Calcium is mostly bound to albumin, a protein in the blood. Calcium levels can be affected by parathyroid hormone, vitamin D, phosphate, and albumin levels. A client with fluid volume excess may have low calcium levels due to dilution or low albumin levels.

Choice D reason:

Magnesium is not likely to be elevated in a client who has fluid volume excess. Magnesium is mainly found inside the cells and bones, and its levels are regulated by the kidneys. Magnesium levels can be affected by renal function, intestinal absorption, hormonal factors, and medications. A client with fluid volume excess may have low magnesium levels due to dilution or increased excretion by the kidneys.

Choice A reason:

Dairy products like milk and cheese are high in phosphorus, which can cause bone loss and cardiovascular problems in clients who have chronic kidney disease. Therefore, avoiding or limiting these foods can help reduce phosphate intake and prevent complications.

Choice B reason:

Salt substitutes often contain potassium, which can accumulate in the blood and cause hyperkalemia in clients who have chronic kidney disease. Hyperkalemia can lead to cardiac arrhythmias and muscle weakness. Therefore, using salt substitutes instead of regular salt is not a good idea.

Choice C reason:

Orange juice and grapefruit juice are both high in potassium, which can cause hyperkalemia in clients who have chronic kidney disease. Therefore, drinking either of these juices does not indicate an understanding of the importance of limiting phosphate intake.

Choice D reason:

Fruits and vegetables like bananas and spinach are also high in potassium, which can cause hyperkalemia in clients who have chronic kidney disease. Moreover, some fruits and vegetables are also high in oxalate, which can increase the risk of kidney stones. Therefore, eating more fruits and vegetables like bananas and spinach does not indicate an understanding of the importance of limiting phosphate intake.

Choice A reason:

Muscle weakness is not a typical symptom of hypocalcemia. Muscle weakness can be caused by many other conditions, such as electrolyte imbalance, dehydration, or muscle injury. Hypocalcemia usually causes muscle cramps or spasms, especially in the back and legs.

Choice B reason:

Constipation is not a common symptom of hypocalcemia. Constipation can be caused by many other factors, such as diet, medication, or lack of physical activity. Hypocalcemia usually affects the nervous system and the muscles, not the digestive system.

Choice C reason:

Facial twitching is a characteristic symptom of hypocalcemia. Facial twitching is also known as Chvostek's sign, which is a test to diagnose hypocalcemia. It involves tapping the facial nerve near the ear and observing if the facial muscles contract involuntarily. Facial twitching occurs because hypocalcemia makes the nerves and muscles more excitable and sensitive to stimulation.

Choice D reason:

Decreased deep tendon reflexes are not a sign of hypocalcemia. Decreased deep tendon reflexes can be caused by many other conditions, such as peripheral neuropathy, spinal cord injury, or hypothyroidism. Hypocalcemia usually causes increased deep tendon reflexes, which is also known as Trousseau's sign. It involves inflating a blood pressure cuff on the arm and observing if the hand and fingers curl inward. This happens because hypocalcemia reduces the threshold for nerve and muscle activation.

• Choice A reason: Dilute the medication in normal saline solution. This is incorrect because magnesium sulfate should be diluted in lactated Ringer's solution, not normal saline solution.

• Choice B reason:

• Infuse the medication over 10 minutes. This is incorrect because magnesium sulfate should be infused over 20 to 30 minutes.

• Choice C reason:

• Monitor the client's blood pressure every 15 minutes. This is incorrect because monitoring the client's blood pressure every 15 minutes is not enough to prevent or detect complications of preeclampsia or magnesium sulfate therapy. The nurse should also monitor the client's respiratory rate, deep tendon reflexes, urine output, and serum magnesium levels.

• Choice D reason:

• Have calcium gluconate available as an antidote. This is correct because calcium gluconate is the antidote for magnesium toxicity, which can cause respiratory depression, cardiac arrest, and coma. Magnesium toxicity can occur if the client has renal impairment, receives too high a dose, or has a low urine output. The nurse should have calcium gluconate readily available and administer it intravenously if signs of magnesium toxicity occur.