A nurse is assisting with the admission of a client who is hyperventilating, reports lightheadedness and paresthesias, has blurred vision, and a new onset of confusion. The nurse should suspect that the client has developed which of the following imbalances?

Rationale:
A. Kidneys are the slowest to respond, so this order is incorrect.
B. Kidneys are slower than lungs, so this order is incorrect.
C. Lungs respond faster than kidneys but slower than chemical buffers, so this order is incorrect.
D. Chemical buffers act immediately to neutralize pH changes (first line), lungs adjust CO₂ levels within minutes (second line), and kidneys regulate acid-base balance over hours to days (third line), making this the correct order.

Rationale:

A. Mix with a dextrose solution only: Potassium can be mixed in various compatible solutions (such as 0.9% NS or D5½NS). There is no requirement that potassium chloride must be mixed only with dextrose-containing fluids.

B. Administer as a rapid IV push: This is dangerous and contraindicated. IV potassium must never be given as a rapid IV push or bolus, as it can cause fatal cardiac arrhythmias. It must be diluted and administered slowly.

C. Monitor for signs of hypernatremia: While electrolyte monitoring is important, hypernatremia is not the main concern when administering potassium. The nurse should focus on monitoring potassium levels and cardiac status.

D. Ensure the infusion is diluted and given via an IV pump: IV potassium chloride must always be diluted in an appropriate IV fluid and administered via an infusion pump to control the rate and avoid complications such as arrhythmias and vein irritation. Also, the infusion rate should typically not exceed 10 mEq/hr through a peripheral vein.