A nurse is caring for a client who has a potassium level of 3.2 mEq/L (3.5 to 5 mEq/L). Which of the following foods should the nurse recommend as being the best source of potassium?

Rationale:

A. "Check your pulse rate for 30 seconds at different times throughout the day.": Clients with pacemakers should check their pulse daily at the same time and for a full minute to ensure the pacemaker is functioning properly. Shorter durations and inconsistent timing may lead to inaccurate assessments.

B. "Limit strenuous physical activity for 8 weeks.” Limiting physical activity, especially involving the upper body, is essential to allow the pacemaker leads to secure in the myocardium. Strain or vigorous movement during the healing phase can displace the leads or disrupt healing.

C. "Remain at least 3 feet away when watching television”: Modern televisions do not emit electromagnetic interference that would affect pacemaker function. There is no need for such distancing, making this instruction inaccurate and unnecessarily restrictive.

D. "Expect to have intermittent, prolonged hiccups.” Persistent hiccups could indicate pacemaker lead displacement or diaphragmatic stimulation and should be reported immediately. They are not an expected or normal finding after pacemaker implantation.

Rationale for correct choices:

• Apply oxygen via nasal cannula: The client is experiencing signs of decreased oxygenation (SpO₂ 92%), shallow respirations, and lethargy, which may indicate central nervous system depression from magnesium sulfate. Administering oxygen improves tissue perfusion and is a priority for maternal and fetal well-being.
• Calcium gluconate: Magnesium sulfate toxicity presents with depressed deep tendon reflexes, lethargy, and respiratory depression. Since the client's DTRs have decreased from 3+ to 1+ and respirations are now shallow, calcium gluconate should be prepared as the antidote to reverse toxicity promptly.

Rationale for incorrect choices:

• Reduce fluid intake: Although the client has reduced urine output and elevated creatinine and BUN levels, there is no indication of fluid overload. Reducing fluids does not address the immediate concern of hypoxia or magnesium toxicity, which are more urgent.
• Discontinue IV infusion: The IV is essential for delivering antihypertensive medications and magnesium sulfate. Discontinuing it would delay critical treatment and worsen the client’s condition. Adjustments, if needed, should follow provider orders after assessment, not be the nurse's initial independent action.
• Hydralazine: Hydralazine is appropriate for severe hypertension but is not the most urgent need when magnesium toxicity is suspected. Managing respiratory compromise and preparing the antidote takes precedence over blood pressure control in this case.
• Nifedipine: Nifedipine was already prescribed and may be administered for ongoing hypertension management. However, it is not used to treat magnesium sulfate toxicity and does not reverse respiratory depression. Thus, while important, it is not the immediate medication to prepare in this scenario.