A client with acute renal injury (AKI) weighs 110.3 pounds (50 kg) and has a potassium level of 6.7 mEq/L (6.7 mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first?

Reference Range:
Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]

a) Basic metabolic panel: This is a blood test that measures the levels of electrolytes, glucose, calcium, and kidney function. It is not a priority order for this client because her glucose level is within the normal range and her symptoms are not indicative of electrolyte imbalance or kidney failure.

b) Echocardiogram: This is a test that uses sound waves to create images of the heart and its valves, chambers, and blood flow. It is not a priority order for this client because her chest discomfort may not be related to a cardiac problem and her SpO2 is normal, indicating adequate oxygenation.

c) CT scan of abdomen: This is a test that uses X-rays to create detailed pictures of the organs and structures in the abdomen. It is not a priority order for this client because her abdominal pain is not severe or acute and her nausea and poor appetite may be due to her illness or dialysis.

d) Blood cultures times 2 sets: This is a test that checks for the presence of bacteria or fungi in the blood. It is not a priority order for this client because she does not have signs of infection such as fever, chills, or leukocytosis.

e) Chest X-ray: This is a test that uses X-rays to create images of the lungs and chest wall. It is not a priority order for this client because she does not have respiratory symptoms such as cough, shortness of breath, or wheezes.

f) Place on continuous cardiac monitor: This is an order that requires the nurse to attach electrodes to the client's chest and monitor the heart rate and rhythm continuously. This is a priority order for this client because she has a history of CAD and HTN and reports chest discomfort and lightheadedness, which could indicate a possible myocardial infarction (heart attack) or arrhythmia (irregular heartbeat).

g) CBC: This is a blood test that measures the number and types of blood cells, such as red blood cells, white blood cells, and platelets. It is not a priority order for this client because she does not have signs of anemia, bleeding, or infection.

h) 12 lead EKG: This is a test that records the electrical activity of the heart from 12 different angles. It can detect abnormalities in the heart's rhythm, conduction, or damage. This is a priority order for this client because she has a history of CAD and HTN and reports chest discomfort and lightheadedness, which could indicate a possible myocardial infarction (heart attack) or arrhythmia (irregular heartbeat).

The client has inhaled smoke, which can cause respiratory problemssuch as airway obstruction, bronchospasm, and pulmonary edema. The client also has initial fluid shifts, which can lead to electrolyte imbalancesuch as hyponatremia, hyperkalemia, and metabolic acidosis.

Choice A: inhaled smoke - respiratory problems

This is a correct choice. Inhaled smoke can damage the respiratory system by causing inflammation, edema, and carbon monoxide poisoning.

Choice B: initial fluid shifts - electrolyte imbalance

This is a correct choice. Initial fluid shifts occur when fluid moves from the intravascular space to the interstitial space due to increased capillary permeability. This can result in electrolyte imbalance such as low sodium, high potassium, and low bicarbonate levels.

Choice C: increased cardiac output - high blood sodium levels

This is an incorrect choice. Increased cardiac output is not a condition that occurs in burn patients. High blood sodium levels are not a common finding in burn patients either. High blood sodium levels can occur due to dehydration or excessive sodium intake.

Choice D: decreased catecholamines - hypometabolism

This is an incorrect choice. Decreased catecholamines are not a finding in burn patients. Catecholamines are hormones that increase heart rate, blood pressure, and metabolism in response to stress. Burn patients have increased catecholamines due to pain and tissue injury. Hypometabolism is also not a condition that occurs in burn patients. Hypometabolism is a state of low metabolic rate that can occur due to starvation, hypothyroidism, or hypothermia. Burn patients have increased metabolism due to increased energy demands for wound healing and thermoregulation.