A nurse in an emergency department (ED) is caring for a female client.

For each potential provider prescription, click to specify if the prescription is appropriate or inappropriate for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Hyperkalemia is a critical electrolyte disturbance defined by a serum potassium level exceeding 5.0 mEq/L, which alters the resting membrane potential of excitable tissues. This condition often results from renal failure, metabolic acidosis, or cellular injury, leading to cardiac dysrhythmias and neuromuscular weakness. Clinical management involves stabilizing the myocardium, shifting potassium intracellularly, and facilitating the definitive excretion of the excess cation from the body to prevent cardiac arrest.

Rationale:

Administering sodium polystyrene rectally is appropriate as it acts as a cation-exchange resin to remove excess potassium from the body. It works in the large intestine by exchanging sodium ions for potassium ions, which are then excreted through the feces. This provides a definitive method for lowering the total body potassium load in a client with a serum level of 6 mEq/L.

Administering potassium chloride IV is inappropriate and life-threatening for this client because their serum potassium level is already critically elevated at 6 mEq/L. Adding more exogenous potassium would exacerbate the hyperkalemic state, leading to worsening cardiac conduction delays or ventricular fibrillation. The primary goal for this client is potassium reduction, not supplementation or replacement.

Administering insulin IV is appropriate because it stimulates the sodium-potassium ATPase pump, facilitating the rapid shift of potassium from the extracellular fluid into the intracellular compartment. This provides a temporary but life-saving reduction in serum potassium levels. Intravenous dextrose is typically co-administered to prevent hypoglycemia unless the client’s blood glucose is already significantly elevated.

Administering hydralazine IV is inappropriate because this client is already experiencing low blood pressure, with a reading of 98/54 mm Hg at 1100. Hydralazine is a direct-acting vasodilator used to treat hypertension by relaxing vascular smooth muscle. Giving a vasodilator to a hypotensive client would lead to severe hemodynamic collapse and further compromise organ perfusion.

Administering calcium gluconate IV is appropriate as a first-line emergency intervention to stabilize the myocardial cell membrane. While calcium does not lower the serum potassium level, it antagonizes the cardiotoxic effects of hyperkalemia by increasing the threshold potential. This helps prevent lethal arrhythmias, such as the progression from the current peaked T waves to sinusoidal rhythms or asystole.