A client with a right hemisphere stroke is eating lunch.
The nurse notes the client is only eating food from the right side of the tray and is unaware of food remaining on the left side. What is the nurse's priority action?

Managing hyperkalemia and burn injuries necessitates rapid assessment and specialized intervention. Understanding the electrophysiology of the heart and the mechanical pressure exerted by burned skin allows nurses to intervene effectively to stabilize cardiac rhythms and maintain peripheral pulses and perfusion.

Choice A rationale

Potassium supplements would exacerbate hyperkalemia, further increasing the extracellular potassium concentration. This would worsen cardiac membrane depolarization, potentially leading to fatal ventricular arrhythmias or asystole. Normal serum potassium levels range from 3.5 to 5.0 mEq/L.

Choice B rationale

Continuous cardiac monitoring is vital because hyperkalemia alters the myocardial resting membrane potential. This can lead to peaked T waves, widened QRS complexes, and cardiac arrest. Constant surveillance allows for immediate detection of life-threatening electrical changes.

Choice C rationale

Calcium gluconate is administered to stabilize the cardiac cell membrane. It does not lower potassium levels but antagonizes the cardiotoxic effects of hyperkalemia by increasing the threshold potential, thereby reducing the risk of lethal arrhythmias.

Choice D rationale

Hemodialysis is the most definitive and rapid method to remove excess potassium from the blood. It is indicated in severe, symptomatic hyperkalemia when medical therapies are insufficient to stabilize the patient or clear the electrolyte.

Choice E rationale

While diuretics like furosemide can increase potassium excretion, they are often too slow for emergency stabilization in severe hyperkalemia with arrhythmias. They require adequate renal perfusion and function, making them a secondary rather than primary intervention.

Addressing end of life care for patients with neurodegenerative diseases requires therapeutic communication and clarification of advance directives. The nurse must apply principles of patient advocacy and ethics to ensure that specific treatment preferences are understood and documented for future implementation.

Choice A rationale

While the healthcare provider must be informed, this response shifts the responsibility away from the nurse at a critical moment of sharing. The nurse should first explore the patient preferences to provide comprehensive support and advocate for their wishes.

Choice B rationale

This open ended question facilitates an exploration of the patient values and specific desires for comfort care. It allows the nurse to document alternative interventions, such as morphine or oxygen, while respecting the patient refusal of invasive life support.

Choice C rationale

An incentive spirometer helps with lung expansion but will not prevent the ultimate neuromuscular respiratory failure associated with ALS. Giving false hope about delaying ventilation is nontherapeutic and ignores the patient expressed desire to avoid intubation entirely.

Choice D rationale

Asking why can be perceived as defensive or judgmental in therapeutic communication. It may make the patient feel they need to justify their choice, rather than allowing them to express their feelings and plan for their end of life..