A nurse cares for a patient who has a serum potassium of 7.5 mEq/L and is exhibiting cardiovascular changes. Which should the nurse implement first?

A serum potassium level of 3.2 mEq/L indicates hypokalemia, which is a potential complication of inhibiting aldosterone secretion and release. Aldosterone plays a key role in potassium regulation in the body by promoting potassium excretion in the kidneys. When aldosterone secretion is inhibited, potassium excretion decreases, leading to an accumulation of potassium in the bloodstream and resulting in hypokalemia. Symptoms of hypokalemia may include muscle weakness, cramping, irregular heartbeat, and fatigue.

B. Urine output of 1,200 mL in the last 2 hours:

This option does not directly relate to complications of inhibiting aldosterone secretion. A urine output of 1,200 mL in the last 2 hours indicates adequate urine production, which is generally a positive sign. However, in the context of inhibiting aldosterone secretion, the nurse would be more concerned about decreased urine output due to potential renal effects.

C. Blood osmolality of 250 mOsm/kg (250 mmol/kg):

Blood osmolality within the normal range (usually around 275-295 mOsm/kg) is not directly associated with complications of inhibiting aldosterone secretion. Blood osmolality reflects the concentration of solutes in the blood and is regulated by various factors, including water balance, electrolyte levels, and hormonal regulation. Inhibiting aldosterone secretion primarily affects electrolyte balance rather than blood osmolality.

D. Urine output of 25 mL/hr:

A urine output of 25 mL/hr is considered low and may indicate decreased renal perfusion or impaired kidney function. Inhibiting aldosterone secretion can affect renal function and urine output, leading to decreased urine production. Reduced urine output can contribute to fluid and electrolyte imbalances and may be a concern in patients with inhibited aldosterone secretion.

E. Serum potassium level of 5.4 mEq/L:

A serum potassium level of 5.4 mEq/L indicates hyperkalemia, which is another potential complication of inhibiting aldosterone secretion. Aldosterone helps regulate potassium levels by promoting potassium excretion in the kidneys. When aldosterone secretion is inhibited, potassium excretion decreases, leading to an accumulation of potassium in the bloodstream and resulting in hyperkalemia. Symptoms of hyperkalemia may include muscle weakness, irregular heartbeat, nausea, and numbness or tingling.

A. Arrange for the patient to receive gamma globulin.

Gamma globulin is a blood product that contains antibodies and is sometimes used for post-exposure prophylaxis in certain situations, such as for individuals who are immunocompromised or pregnant and have been exposed to varicella (chickenpox) or measles. However, for a frail, older adult who had chickenpox as a child and has been exposed to varicella again, arranging for gamma globulin may not be necessary if the patient is already immune to chickenpox.

B. Assess frequently for herpes zoster.

Herpes zoster (shingles) is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. While exposure to varicella can increase the risk of developing shingles in individuals who are susceptible, frequent assessment for herpes zoster is not necessary in this case if the patient is known to have had chickenpox in the past.

C. Be aware of the patient's immunity to chickenpox.

This option is the correct choice. Since the patient had chickenpox as a child, they likely have immunity to chickenpox. Being aware of this immunity helps the nurse understand that the patient may not develop chickenpox again even after exposure to varicella.

D. Encourage the patient to have a pneumonia vaccine.

Encouraging the patient to have a pneumonia vaccine is unrelated to the immediate concern of exposure to varicella. While pneumonia vaccines are important for older adults, especially those who are frail, the priority in this scenario is to determine the patient's immunity to chickenpox due to prior infection.