A nurse is preparing to administer cephalexin to a client in the preoperative holding area. Which assessment finding causes the nurse to clarify the prescription with the provider?

A.Severe hypokalemia significantly alters the resting membrane potential of myocardial cells, increasing the risk of lethal ventricular dysrhythmias. Continuous electrocardiographic monitoring is essential during intravenous replacement to detect premature ventricular contractions or heart block. This allows the nurse to intervene immediately if the infusion rate causes rapid shifts in cardiac electrical conduction.

B.Furosemide is a loop diuretic that causes significant renal potassium wasting by inhibiting the sodium-potassium-chloride cotransporter. Providing education on potassium-rich dietary sources helps the client maintain electrolyte homeostasis and prevents future episodes of profound deficiency. Nutritional management is a key component of long-term therapy for patients requiring chronic diuretic use for fluid volume management.

C.Drawing serum potassium levels immediately after an infusion provides an inaccurate reflection of the total body potassium stores due to incomplete equilibration. Potassium is primarily an intracellular cation, and premature testing only measures the transiently high intravascular concentration. Protocols typically require waiting several hours after the infusion ends to ensure the laboratory results reflect a true systemic steady state.

D.Preparing potassium infusions solely with 5% dextrose can be counterproductive because glucose stimulates insulin release, which shifts potassium from the extracellular fluid into the cells. This intracellular shift can actually lower the serum potassium level further during the initial phase of administration. Saline-based solutions are often preferred to ensure that the administered potassium remains in the vascular space to correct the deficit.

E.Potassium is primarily excreted by the kidneys, and administration in the presence of oliguria or renal failure can lead to rapid, life-threatening hyperkalemia. Verifying adequate renal function, defined as an output of at least 0.5 to 1 mL/kg/hour, ensures the body can safely process and excrete the supplemental mineral. This nursing action is a critical safety barrier against the development of iatrogenic potassium toxicity.

A.Prednisone is a corticosteroid that frequently causes fluid retention and increased appetite, typically leading to weight gain rather than weight loss. Clients often develop a "moon face" or truncal obesity as a result of altered fat distribution and sodium retention. Expecting weight loss indicates a misunderstanding of the metabolic side effects of long-term glucocorticoid therapy, requiring further education on dietary monitoring and calorie control.

B.Taking NSAIDs like aspirin or ibuprofen while on prednisone significantly increases the risk of gastrointestinal ulceration and hemorrhage. Both drug classes are irritating to the gastric mucosa and interfere with the protective prostaglandin barrier in the stomach. The nurse must instruct the client to avoid these combinations and instead use acetaminophen or other prescribed agents that do not exacerbate the risk of peptic ulcer disease.

C.A sore throat is not a normal or expected side effect of prednisone and could indicate the development of an opportunistic infection, such as oral candidiasis, due to immunosuppression. Prednisone inhibits the inflammatory response, which can mask early signs of infection while making the client more susceptible to pathogens. The client should be taught to report any symptoms of infection, like a sore throat or fever, to the provider immediately.

D.Corticosteroids like prednisone can cause increased urinary excretion of potassium, leading to hypokalemia. Increasing dietary intake of potassium-rich foods, such as bananas, helps to counteract this effect and maintain normal electrolyte balance. This statement demonstrates that the client understands the importance of nutritional interventions to mitigate the metabolic complications associated with chronic steroid use for their rheumatoid arthritis management.