A nurse is preparing to administer phenytoin IV to a client who had a tonic-clonic seizure. Which of the following actions should the nurse plan to take?

Sodium polystyrene sulfonate is a cation-exchange resinutilized in the management of hyperkalemia. It works in the large intestine by exchanging sodium ions for potassium ions, allowing the excess potassiumto be excreted from the body via the feces to prevent cardiac complications.

Rationale:

A.While sodium polystyrene sulfonate can lead to a secondary decrease in calcium levels as a side effect, calcium is not the target of the medication. Monitoring calcium is important for safety, but it does not measure the primary effectiveness of the drug. The drug is specifically formulated to treat potassium imbalances that pose immediate risks to the myocardium.

B.Potassium is the primary laboratory value to monitor because the therapeutic goal of sodium polystyrene sulfonate is to lower serum potassium levels. Effectiveness is confirmed when the lab results show a return toward the normal range of 3.5 to 5.0 mEq/L. Since high potassium can cause fatal arrhythmias, this lab provides the definitive proof of the medication's clinical success.

C.Sodium levels may increase during therapy because the resin releases sodium in exchange for potassium, but this is a side effect rather than a measure of efficacy. Monitoring sodium is necessary to prevent hypernatremia and fluid retention, especially in heart failure patients. However, the nurse prioritizes the potassium level to ensure the life-threatening hyperkalemia has been resolved.

D.Magnesium levels are not the primary focus for evaluating the effectiveness of this exchange resin. While electrolyte shifts can occur broadly during diuresis or bowel clear-out, sodium polystyrene sulfonate has a specific affinity for potassium. The nurse should monitor magnesium for general electrolyte balance, but it does not serve as a benchmark for the medication's intended therapeutic action.

The pharmacological management of acute maniainvolves mood stabilizers and antipsychotics to achieve rapid symptomatic control. Safety standards prohibit the use of trailing zerosin medication orders to prevent ten-fold dosing errors. A decimal point followed by a zero can be easily misread in a clinical environment, leading to iatrogenic harmand severe medication toxicity.

Rationale:

A.Risperidone 3.0 mg contains a trailing zero, which is a dangerous notation that must be clarified and corrected to 3 mg. If the decimal point is not clearly visible, a clinician might mistakenly administer 30 mg, which could lead to severe extrapyramidal symptoms or neuroleptic malignant syndrome. Following the "Do Not Use" list from The Joint Commission is essential for patient safety.

B.Clonazepam 0.5 mg is a correctly formatted prescription for a benzodiazepine often used as an adjunct in mania to promote sedation and reduce agitation. The leading zero before the decimal point is required to prevent the dose from being read as 5 mg. Since this order follows safe labeling practices and falls within therapeutic ranges, it does not require clarification.

C.Lithium 300 mg is a standard starting dose for a primary mood stabilizer used in the treatment of bipolar disorder. The order is written clearly without dangerous abbreviations or incorrect decimal placements. Because the dose is typical for achieving a therapeutic serum concentration between 0.8 and 1.2 mEq/L, the nurse can proceed with administration and monitoring.

D.Divalproex sodium 0.5 g is an anticonvulsant mood stabilizer written using a leading zero, which is the correct safety format for decimal values. While often prescribed in milligrams (500 mg), the use of grams is clear and follows standard metric notation. There is no ambiguity in this order that would increase the risk of a significant medication error for the patient.