A nurse is assisting with preparations for administering intravenous potassium replacement supplements to a client who has a potassium level of 2.5 mEq/L. Which of the following actions should the nurse plan to include? (Select all that apply.)

Repeat blood serum potassium

Educate client regarding high-potassium food sources

Cardiac monitoring during infusion

Ensure that the client's urine output is at least 1 mL/kg/hour

Ensure potassium infusion is prepared with 5% dextrose solution

Answer and Explanation

Correct Answer : C,D

A. Repeat blood serum potassium: While it’s important to monitor potassium levels, the immediate priority when preparing to administer potassium is ensuring safe administration practices, not rechecking levels before initiating therapy.

B. Educate client regarding high-potassium food sources: Client education is important for long-term management but is not a priority when preparing for intravenous potassium replacement in an acute setting.

C. Cardiac monitoring during infusion: Potassium affects cardiac conduction, and rapid correction can lead to arrhythmias. Continuous cardiac monitoring is necessary to detect any life-threatening arrhythmias during the infusion.

D. Ensure that the client's urine output is at least 1 mL/kg/hour: Adequate urine output ensures that the kidneys are functioning and capable of excreting excess potassium, reducing the risk of hyperkalemia.

E. Ensure potassium infusion is prepared with 5% dextrose solution: Potassium should not be mixed with dextrose, as it can increase insulin release, causing potassium to shift into cells and worsen hypokalemia.

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Correct Answer is D

Explanation

A. Fever: Although fever can occur with various respiratory conditions, it is not the most specific early sign of an exacerbation in pulmonary sarcoidosis.

B. Weight loss: Weight loss is a more general symptom and not specifically indicative of an exacerbation of sarcoidosis.

C. Fatigue: Fatigue is a common symptom of sarcoidosis but is not necessarily an early sign of an exacerbation.

D. Shortness of breath: Shortness of breath is a significant early indicator of exacerbation in pulmonary sarcoidosis. It reflects worsening inflammation and granuloma formation affecting lung function.

A. Bradypnea B. Cyanosis C. Pallor D. Bradycardia

Correct Answer is B

Explanation

A. Bradypnea, or abnormally slow breathing, is not typically associated with hypoxia. Hypoxia usually triggers an increase in respiratory rate (tachypnea) as the body attempts to take in more oxygen to meet its needs.
B. Cyanosis, a bluish discoloration of the skin and mucous membranes, is a key sign of hypoxia. It occurs when there is insufficient oxygen in the blood, leading to a darker color of deoxygenated hemoglobin. Cyanosis is most commonly observed in the lips, fingertips, and toes.
C. Pallor, or paleness of the skin, can occur in various conditions but is not specific to hypoxia. It is more commonly associated with anemia or shock rather than low oxygen levels in the blood.
D. Bradycardia, or a slower-than-normal heart rate, is not typically a manifestation of hypoxia. Instead, hypoxia often causes tachycardia as the body attempts to increase oxygen delivery to tissues by pumping blood more quickly.

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A nurse is assisting with preparations for administering intravenous potassium replacement supplements to a client who has a potassium level of 2.5 mEq/L. Which of the following actions should the nurse plan to include? (Select all that apply.)

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