A client with obstructive sleep apnea (OSA) calls the clinic to report difficulty wearing the continuous positive air pressure (CPAP) mask because it is uncomfortable. The client asks the nurse for an alternative way to manage sleep apnea. Which recommendation should the nurse provide?

Choice A reason: Potassium 4.7 mEq/L (4.70 mmol/L) is within the normal reference range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Potassium is an electrolyte that helps regulate the balance of fluids and acids in the body, as well as the function of nerves and muscles. A high potassium level (hyperkalemia) can cause muscle weakness, irregular heartbeat, and cardiac arrest. A low potassium level (hypokalemia) can cause muscle cramps, fatigue, and arrhythmias.

Choice B reason: Magnesium 2.1 mEq/L (0.86 mmol/L) is within the normal reference range of 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). Magnesium is an electrolyte that helps regulate the activity of enzymes, muscles, and nerves, as well as the balance of calcium and potassium in the body. A high magnesium level (hypermagnesemia) can cause nausea, vomiting, flushing, muscle weakness, and respiratory depression. A low magnesium level (hypomagnesemia) can cause muscle twitching, tremors, seizures, and cardiac arrhythmias.

Choice C reason: Calcium 6.5 mg/dL (1.63 mmol/L) is below the normal reference range of 9 to 10.5 mg/dL (2.3 to 2.6 mmol/L). Calcium is an electrolyte that helps regulate the function of muscles, nerves, bones, and blood clotting. A high calcium level (hypercalcemia) can cause nausea, vomiting, constipation, confusion, kidney stones, and bone pain. A low calcium level (hypocalcemia) can cause muscle spasms, cramps, tingling, numbness, and stridor (a high-pitched sound when breathing). **This is a critical value that should be immediately reported to the healthcare provider**, as it can indicate a serious condition such as acute pancreatitis, sepsis, or massive blood transfusion.

Choice D reason: Sodium 135 mEq/L (135 mmol/L) is slightly below the normal reference range of 136 to 145 mEq/L (136 to 145 mmol/L). Sodium is an electrolyte that helps regulate the balance of fluids and acids in the body, as well as the function of nerves and muscles. A high sodium level (hypernatremia) can cause thirst, dry mouth, confusion, seizures, and coma. A low sodium level (hyponatremia) can cause headache, nausea, vomiting, fatigue, muscle weakness, and confusion.

Choice A reason: An abdominal catheter is used for peritoneal dialysis, not hemodialysis. Hemodialysis requires access to a large blood vessel, usually in the arm or leg.

Choice B reason: Routine medications may need to be adjusted or avoided before or after hemodialysis, depending on their effects on blood pressure, fluid balance, and electrolytes.

Choice C reason: Insulin dosage may need to be reduced during hemodialysis because insulin is removed by the dialyzer and blood glucose levels may drop. This is the correct statement to include in client education.

Choice D reason: Potassium-rich foods should be limited in the diet of clients with chronic kidney disease and hemodialysis, because potassium can build up in the blood and cause cardiac arrhythmias.