A nurse is assisting with the evaluation of a facility's safety plan. Which of the following indicates that the safety plan is effective?

A) Irregular heart rate: An irregular heart rate is a key manifestation of hyperkalemia. Elevated potassium levels can interfere with the normal electrical activity of the heart, leading to arrhythmias, which can cause an irregular heart rate. In severe cases, hyperkalemia can lead to life-threatening cardiac events such as ventricular fibrillation or asystole.

B) Dry mucous membrane: Dry mucous membranes are more commonly associated with dehydration, not hyperkalemia. Dehydration can cause fluid volume depletion, which leads to dry mouth and other signs of insufficient hydration. While renal failure can lead to fluid balance issues, dry mucous membranes are not typically linked to elevated potassium levels.

C) Trousseau's sign: Trousseau's sign is a clinical indicator of hypocalcemia, not hyperkalemia. It is a spasm of the hand and wrist that occurs when a blood pressure cuff is inflated above systolic pressure for several minutes. This sign suggests low calcium levels, and while calcium imbalance can occur in renal failure, it is unrelated to hyperkalemia.

D) Hyperactive reflexes: Hyperactive reflexes are more commonly associated with conditions like hypocalcemia, rather than hyperkalemia. In hyperkalemia, the typical findings include muscle weakness or paralysis due to the effect of potassium on muscle and nerve function, but hyperactive reflexes would not be expected.

D. Facial nerve assessment: The development of left facial droop and asymmetry postoperatively suggests potential facial nerve (cranial nerve VII) injury during the stapedectomy. This requires immediate evaluation to determine if it is temporary due to surgical manipulation or a sign of nerve damage.
E. Vertigo: Postoperative vertigo and nausea are common but should be monitored closely because stapedectomy involves inner ear structures responsible for balance. Persistent or worsening vertigo may indicate inner ear trauma or perilymphatic fistula, requiring further assessment.

Incorrect:
A. Pain rating: Pain is expected after surgery and can be managed with prescribed analgesics.
B. Lung assessment: Bilateral clear breath sounds do not indicate respiratory distress or complications.
C. Pupils: The slight decrease in pupil size (3.5 mm to 3 mm) is not clinically significant and remains within normal limits.
F. Diminished hearing: Hearing loss is expected post-stapedectomy due to packing in the ear and middle ear healing. Improvement typically occurs over weeks.