The nurse is caring for the client with cardiac and renal disease. The client now has a serum potassium level of 6.0 mEq/L. Which medications, if prescribed, should the nurse administer? Select all that apply.

Calcium gluconate 1.5 grams IV now

Dextrose 50% injection (50ml) IV push now

Colace 100 mg PO now

Regular insulin 10 units IV now

Potassium chloride 20 mEq orally now

Answer and Explanation

Correct Answer : A,B,D

A) Calcium gluconate 1.5 grams IV now: Calcium gluconate is administered to counteract the effects of hyperkalemia by stabilizing the myocardial cell membrane. It does not lower potassium levels but helps protect the heart from potential dysrhythmias associated with high potassium levels.

B) Dextrose 50% injection (50ml) IV push now: Dextrose 50% injection, also known as D50W, is administered to temporarily shift potassium from the extracellular space into the intracellular space, thereby lowering serum potassium levels. It is commonly used in combination with insulin to facilitate the movement of potassium into cells.

C) Colace 100 mg PO now: Colace is a stool softener and does not affect serum potassium levels. It is not indicated for the treatment of hyperkalemia.

D) Regular insulin 10 units IV now: Regular insulin is administered with dextrose to facilitate the movement of potassium from the extracellular space into the intracellular space. Insulin stimulates the cellular uptake of glucose, which in turn drives potassium into cells along with glucose.

E) Potassium chloride 20 mEq orally now: Potassium chloride is contraindicated in the treatment of hyperkalemia as it would further increase serum potassium levels. It is typically used to supplement potassium in clients with hypokalemia, not hyperkalemia.

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Correct Answer is D

Explanation

A) Asking the client to cough while inserting the NG tube:
This action is not necessary and may not be appropriate during the insertion of an NG tube. Coughing can increase the risk of gagging and aspiration during the procedure.

B) Wearing sterile gloves to insert the NG tube:
While the nurse should maintain appropriate hand hygiene, wearing sterile gloves is not typically necessary for the insertion of an NG tube. Clean gloves are sufficient for this procedure.

C) Placing the client into a left lateral position before inserting the NG tube:
Positioning the client in a high Fowler's position (sitting upright) or semi-Fowler's position is generally preferred for NG tube insertion to facilitate tube passage into the esophagus and reduce the risk of aspiration. Placing the client in a left lateral position is not typically done for NG tube insertion.

D) Determining the length of the NG tube to be inserted prior to the procedure:
This is the correct action. Before inserting the NG tube, the nurse should measure the distance from the tip of the client's nose to the earlobe and then from the earlobe to the xiphoid process or the mark on the NG tube corresponding to the desired insertion length. This helps ensure that the tube is inserted to the appropriate depth and reaches the desired location within the gastrointestinal tract.

A. Lavender B. Orange C. Peppermint D. Ginger

Correct Answer is A

Explanation

A. Lavender:
Lavender essential oil is well-known for its calming and relaxing properties. It is often used to promote sleep and alleviate insomnia symptoms. Research suggests that inhaling lavender aroma or using lavender oil in aromatherapy can help improve sleep quality by reducing anxiety and promoting relaxation.

B. Orange:
While orange essential oil has a refreshing and uplifting scent, it is not typically used to promote sleep. Instead, it is often used to boost mood and energy levels due to its citrusy aroma.

C. Peppermint:
Peppermint essential oil has a stimulating and invigorating scent, making it more suitable for promoting alertness and mental clarity rather than inducing sleep. It is commonly used to alleviate fatigue and increase focus.

D. Ginger:
Ginger essential oil has a warm and spicy aroma that is often used for its energizing and revitalizing effects. Similar to peppermint, ginger is not typically used to promote sleep but may help alleviate fatigue and increase mental alertness.

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The nurse is caring for the client with cardiac and renal disease. The client now has a serum potassium level of 6.0 mEq/L. Which medications, if prescribed, should the nurse administer? Select all that apply.

Nursing Test Bank

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