A nurse is caring for a client who states, "I did not take my medication because my partner forgot to remind me." The nurse should identify that the client is demonstrating which of the following defense mechanisms?

Choice A reason: This is the correct answer because stopping the KCl infusion is the first and most urgent action that the nurse should take. A high level of potassium in the blood, or hyperkalemia, can cause life-threatening cardiac arrhythmias and muscle weakness. The nurse should stop the source of excess potassium, which is the KCl infusion, and monitor the client's vital signs, electrocardiogram, and symptoms.

Choice B reason: This is not the correct answer because administering oral KCl is not the first or appropriate action that the nurse should take. Oral KCl would increase the potassium level in the blood, which is already too high. The nurse should avoid giving any potassium supplements or foods that are high in potassium, such as bananas, oranges, and potatoes.

Choice C reason: This is not the correct answer because encouraging fluids for dilution is not the first or effective action that the nurse should take. Fluids alone would not lower the potassium level in the blood, but rather dilute the concentration of other electrolytes, such as sodium and calcium. The nurse should administer fluids only as prescribed by the physician, and in conjunction with other treatments, such as diuretics, insulin, or sodium bicarbonate.

Choice D reason: This is not the correct answer because calling the pharmacy is not the first or priority action that the nurse should take. Calling the pharmacy may be necessary to obtain the medications that can lower the potassium level in the blood, such as diuretics, insulin, or sodium bicarbonate. However, the nurse should first stop the KCl infusion and notify the physician, who will order the appropriate medications and dosages.

Choice A reason: Encouraging the patient to wait for 24 hours before applying new knowledge is not an effective strategy to promote learning. It may cause the patient to forget or lose interest in the information. The RN should encourage the patient to apply new knowledge as soon as possible to reinforce learning and improve retention.

Choice B reason: Organizing the content from complex to simple is not an effective strategy to promote learning. It may confuse or overwhelm the patient with too much information at once. The RN should organize the content from simple to complex, starting with the most essential and relevant information and building on it gradually.

Choice C reason: Repeating the key concepts is an effective strategy to promote learning. It helps the patient to remember and recall the important information and clarify any misunderstandings. The RN should repeat the key concepts at the beginning, during, and at the end of the lesson.

Choice D reason: Asking the patient to hold questions until after the lesson is completed is not an effective strategy to promote learning. It may discourage the patient from asking questions or expressing concerns that may affect their learning. The RN should encourage the patient to ask questions at any time and provide feedback and answers.