A nurse is caring for a client who has hyperkalemia and is receiving insulin therapy.
Which of the following should the nurse recognize as an adverse outcome?
Serum glucose 58 mg/dL (74 to 106 mg/dL).
Serum sodium 138 mEq/L (136 to 145 mEq/L).
Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL).
Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L).
The Correct Answer is A
Choice A rationale
A serum glucose of 58 mg/dL indicates hypoglycemia, which is a significant adverse outcome of insulin therapy. When insulin is administered to treat hyperkalemia, it works by shifting potassium into the cells along with glucose. This is why glucose is usually co-administered with insulin in these cases. If the insulin effect outweighs the glucose provided, the blood sugar drops below the normal range of 74 to 106 mg/dL. This can lead to central nervous system dysfunction, seizures, or coma if not corrected.
Choice B rationale
A serum sodium level of 138 mEq/L falls well within the normal physiological range of 136 to 145 mEq/L. Sodium is the primary extracellular cation responsible for maintaining osmotic pressure and fluid balance. Insulin therapy does not typically have a direct adverse effect on sodium levels. Since this value is normal, it does not represent an adverse outcome or a complication of the treatment being provided for hyperkalemia. The nurse would consider this a stable and expected laboratory finding.
Choice C rationale
A calcium level of 10.0 mg/dL is within the normal reference range of 9.0 to 10.5 mg/dL. Calcium is essential for myocardial contractility, nerve impulse transmission, and blood clotting. While intravenous calcium gluconate is often given in hyperkalemia to stabilize the cardiac membrane, the administration of insulin itself does not usually cause fluctuations in serum calcium levels. Therefore, a normal calcium result is not an adverse outcome, but rather an indication of electrolyte stability in the client.
Choice D rationale
A serum potassium of 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L. In a client being treated for hyperkalemia, which is defined as a potassium level greater than 5.0 mEq/L, this result indicates that the insulin therapy has been successful in lowering the potassium to a safe level. This is the desired therapeutic effect of the medication, not an adverse outcome. The nurse should continue to monitor the patient but can be reassured by this normalization.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Lactulose is a synthetic sugar used primarily to treat constipation or hepatic encephalopathy. Its mechanism of action involves drawing water into the bowel and trapping ammonia in the gut to be excreted. It has no direct effect on serum potassium levels. In a patient with a potassium level of 6.8 mEq/L, which is significantly higher than the normal range of 3.5 to 5.0 mEq/L, lactulose would provide no therapeutic benefit for hyperkalemia.
Choice B rationale
Sevelamer is a phosphate binder used to treat hyperphosphatemia, commonly in patients with chronic kidney disease. It works by binding to dietary phosphorus in the gastrointestinal tract, preventing its absorption. While electrolyte imbalances often occur together in renal patients, sevelamer does not lower potassium. Using it for a potassium level of 6.8 mEq/L would be inappropriate as it does not address the life-threatening risk of cardiac arrhythmias associated with such high potassium.
Choice C rationale
Sodium polystyrene sulfonate is a cation-exchange resin specifically indicated for the treatment of hyperkalemia. It works in the intestines by exchanging sodium ions for potassium ions, which are then excreted from the body in the feces. A serum potassium level of 6.8 mEq/L is dangerously high, as the normal range is 3.5 to 5.0 mEq/L. Administering this medication helps lower the total body potassium and prevent the severe cardiac complications associated with hyperkalemia.
Choice D rationale
Darbepoetin alfa is an erythropoiesis-stimulating agent used to treat anemia, particularly in patients with chronic kidney disease or those receiving chemotherapy. It works by stimulating the bone marrow to produce more red blood cells. It has no physiological role in the regulation or excretion of potassium. Therefore, it is not an appropriate intervention for a patient presenting with a serum potassium level of 6.8 mEq/L, which requires urgent potassium-lowering therapy to ensure safety.
Correct Answer is C
Explanation
Choice A rationale
Regional anesthesia involves the injection of local anesthetics around specific nerves or the spinal cord to block sensation in a large area of the body, such as a limb or the lower abdomen. During regional anesthesia, the client remains conscious and arousable unless supplemental sedation is provided. It does not induce a state of unconsciousness. Because the client can still interact and breathe independently, it does not meet the criteria for being completely non-arousable.
Choice B rationale
Moderate sedation, previously known as conscious sedation, involves the administration of sedatives and analgesics to induce a depressed level of consciousness. A key characteristic of this type of anesthesia is that the client remains able to respond purposefully to verbal commands or light tactile stimulation. They maintain their own airway and spontaneous ventilation. Since the client is meant to stay arousable throughout the procedure, this choice does not fit the description of being non-arousable.
Choice C rationale
General anesthesia is a drug-induced loss of consciousness during which the client is not arousable, even by painful or noxious stimuli. It involves the suppression of central nervous system activity, leading to a loss of protective reflexes and often requiring assistance with maintaining a patent airway. This state is necessary for major surgical procedures. The inability to be awakened or respond to the environment distinguishes general anesthesia from lighter forms of sedation or local nerve blocks.
Choice D rationale
Local anesthesia is the loss of sensation in a very small, specific area of the body without any loss of consciousness. It is typically achieved by injecting a medication like lidocaine directly into the tissues or applying it topically. The client remains fully awake, alert, and oriented throughout the procedure. There is no systemic effect on the client’s level of arousal. Therefore, the client remains completely arousable, making this choice incorrect for the nurse's teaching.
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