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The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

Sodium bicarbonate

Albuterol

Kayexalate

Metoprolol (Lopressor)

E. Insulin & dextrose

F. Calcium Gluconate

Answer and Explanation

Correct Answer : B,C,E,F

The correct answers are B, C, E, and F.

Rationale for each choice:

Albuterol

Mechanism of action: Albuterol is a beta-2 agonist that stimulates beta-2 receptors in the cell membranes of skeletal muscle, liver, and adipose tissue. This stimulation causes an increase in intracellular cyclic AMP (cAMP), which activates protein kinase A (PKA). PKA then phosphorylates a number of proteins, including the sodium-potassium ATPase pump. This pump is responsible for transporting potassium ions into cells and out of the bloodstream. By increasing the activity of this pump, albuterol can help to lower serum potassium levels.

Onset of action: Albuterol has a rapid onset of action, typically within 30 minutes.

Duration of action: The duration of action of albuterol is relatively short, usually 4-6 hours.

Dosage: The dosage of albuterol for hyperkalemia is typically 10-20 mg nebulized every 4-6 hours.

Additional considerations: Albuterol can cause tachycardia and tremors. It should be used cautiously in patients with heart disease or hyperthyroidism.

Kayexalate

Mechanism of action: Kayexalate is a cation exchange resin that binds to potassium ions in the gastrointestinal tract. This prevents the potassium from being absorbed into the bloodstream.

Onset of action: Kayexalate has a relatively slow onset of action, usually 1-2 hours.

Duration of action: The duration of action of Kayexalate is relatively long, usually 4-6 hours.

Dosage: The dosage of Kayexalate for hyperkalemia is typically 15-30 grams orally or rectally every 6 hours.

Additional considerations: Kayexalate can cause constipation and hypocalcemia. It should be used cautiously in patients with bowel obstruction or kidney disease.

Insulin & dextrose

Mechanism of action: Insulin promotes the movement of potassium into cells, thus lowering serum potassium levels. Dextrose is given along with insulin to prevent hypoglycemia.

Onset of action: Insulin has a rapid onset of action, typically within 30 minutes.

Duration of action: The duration of action of insulin is relatively short, usually 4-6 hours.

Dosage: The dosage of insulin for hyperkalemia is typically 10 units of regular insulin IV push, followed by an infusion of 5-10 units per hour. The dosage of dextrose is typically 50 grams IV push, followed by an infusion of 10% dextrose at 100 mL/hour.

Additional considerations: Insulin can cause hypoglycemia. It should be used cautiously in patients with diabetes mellitus.

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Correct Answer is A

Explanation

Choice A rationale:

Amniocentesis is the most reliable and direct method to assess fetal lung maturity. It involves the extraction of a small sample of amniotic fluid from the amniotic sac, which surrounds the fetus in the uterus. This fluid contains various substances, including surfactant, which is a crucial substance produced by the fetal lungs that enables them to expand and function properly after birth.

By analyzing the levels of surfactant and other components in the amniotic fluid, clinicians can accurately determine the maturity of the fetal lungs. This information is essential in guiding decisions about potential delivery options, especially in cases of preterm labor or other complications that may necessitate early delivery.

Amniocentesis is generally considered a safe procedure, but it does carry some small risks, such as infection, bleeding, or amniotic fluid leakage. However, these risks are typically outweighed by the benefits of obtaining accurate information about fetal lung maturity when necessary.

Choice B rationale:

Fetal fibronectin (fFN) is a protein that is found in the amniotic fluid and cervicovaginal secretions. Elevated levels of fFN in cervicovaginal secretions between 22 and 34 weeks of gestation can indicate an increased risk of preterm labor.

However, fFN testing is not a direct measure of fetal lung maturity. It is used primarily as a screening tool to assess the risk of preterm birth, not to determine the readiness of the fetal lungs for delivery.

Choice C rationale:

Chorionic villus sampling (CVS) is a prenatal diagnostic test that involves taking a small sample of chorionic villi, which are tiny finger-like projections of placental tissue. This test is typically performed earlier in pregnancy (between 10 and 13 weeks gestation) to diagnose genetic abnormalities in the fetus.

CVS is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.

Choice D rationale:

Alpha-fetoprotein (AFP) is a protein produced by the fetal liver. Elevated levels of AFP in the maternal blood can indicate an increased risk of certain birth defects, such as neural tube defects.

AFP testing is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.

A. “Huntington’s disease is diagnosed in childhood.” B. “If you are a carrier, there is a 25% chance your child will inherit the gene.” C. “Only one copy of the variant gene is needed for expression of the disease.” D. “You only need to be referred to a genetic counselor if you are a carrier.”

Correct Answer is C

Explanation

The correct answer is C. Only one copy of the variant gene is needed for expression of the disease.

Choice A rationale:

Huntington's disease (HD) is not typically diagnosed in childhood. While symptoms can sometimes manifest in adolescence or early adulthood, the average age of onset is between 30 and 50 years old.

Early-onset HD, which occurs before the age of 20, is much rarer and accounts for only about 5-10% of cases.

It's crucial to convey accurate information about the typical age of onset to avoid unnecessary anxiety and unwarranted testing in children.

Choice B rationale:

The statement "If you are a carrier, there is a 25% chance your child will inherit the gene" is not entirely accurate for autosomal dominant disorders like HD.

If a parent has HD, each child has a 50% chance of inheriting the mutated gene, not 25%. This is because the parent with HD has one mutated copy of the gene and one normal copy.

During conception, each child randomly receives one copy of the gene from each parent. Therefore, there's a 50% chance the child will receive the mutated copy and a 50% chance they'll receive the normal copy.

Choice D rationale:

Referral to a genetic counselor is essential for all individuals with a family history of HD, regardless of their carrier status.

Genetic counselors can provide comprehensive information about HD, including: Inheritance patterns

Risk assessment

Testing options

Reproductive options

Support resources

Psychosocial counseling

They can assist individuals in making informed decisions about testing, family planning, and management of the condition.

Choice C is the correct answer because:

HD is indeed an autosomal dominant disorder, meaning that only one copy of the mutated gene is needed for an individual to develop the disease.

This contrasts with autosomal recessive disorders, which require two copies of the mutated gene (one from each parent) for the disease to manifest.

Understanding the pattern of inheritance is crucial for accurate risk assessment and genetic counseling.

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The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 40-year-old pregnant patient, currently hospitalized for preterm labor at 34 weeks’ gestation, is discussing potential delivery options with her provider based on the results of a fetal lung maturity test. Which prenatal test would the provider likely order to check for fetal lung maturity?

Correct Answer is A

Explanation

During the initial prenatal visit, the nurse completes a history for a 25-year-old G1PO client. During the interview, the client states her mother has been diagnosed with Huntington’s Disease. Which of the following is a correct statement by the nurse about this autosomal dominant disorder?

Correct Answer is C

Explanation

A pregnant woman is getting ready for a chorionic villus sampling procedure at 10 weeks. The nurse has been educating her about the procedure. Which of the following statements, if made by the client, would indicate that the teaching has been effective?

To help pregnant clients manage discomfort and pain during labor, what is a nurse aware of?

The nurse is discussing the pros and cons of IV opioid administration during active labor with a client. Which statement by the client indicates a need for further education?

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The nurse is assessing a newborn after delivery and observes the following: epicanthal folds, heart murmur, low-set ears, and poor muscle tone. What does the nurse suspect?

Which of the following practices reflect safe administration of oxytocin (Pitocin)?

In the diuretic phase of renal failure, which of the following happens?

When assessing the knowledge of new parents of a child born with Maple Syrup Urine Disease (MSUD), an autosomal recessive inherited disorder, which statement is true?