A nurse is caring for a client during a routine prenatal visit.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Choice A reason: Obtain a 12-lead ECG

Obtaining a 12-lead ECG is a critical action when a client has a potassium level of 6.8 mEq/L, which indicates hyperkalemia. Hyperkalemia can cause serious cardiac dysrhythmias, including life-threatening arrhythmias such as ventricular fibrillation or asystole. An ECG can help detect these abnormalities early, allowing for prompt intervention to prevent cardiac complications. The ECG may show characteristic changes such as peaked T waves, widened QRS complexes, and prolonged PR intervals, which are indicative of hyperkalemia.

Choice B reason: Suggest that the client use a salt substitute

Suggesting that the client use a salt substitute is not appropriate in this situation. Many salt substitutes contain potassium chloride, which can further increase the potassium level in the blood. For a client with hyperkalemia, it is crucial to avoid additional sources of potassium to prevent exacerbating the condition. Therefore, recommending a salt substitute could be harmful.

Choice C reason: Advise the client to add citrus juices and bananas to her diet

Advising the client to add citrus juices and bananas to her diet is also inappropriate. Both citrus juices and bananas are high in potassium and can contribute to an increase in serum potassium levels. For a client with hyperkalemia, it is essential to limit dietary potassium intake to help lower the potassium levels in the blood. Encouraging the consumption of high-potassium foods would be counterproductive and potentially dangerous.

Choice D reason: Obtain a blood sample for a serum sodium level

While obtaining a blood sample for a serum sodium level can be part of a comprehensive assessment, it is not the immediate priority in managing hyperkalemia. The primary concern with a potassium level of 6.8 mEq/L is the risk of cardiac dysrhythmias. Therefore, obtaining an ECG to monitor the heart’s electrical activity is the most urgent and appropriate action. Once the immediate risk is addressed, further laboratory tests, including serum sodium levels, can be conducted as part of the overall assessment and management plan.

Choice A reason:

Metoprolol is a beta-blocker commonly used to treat high blood pressure (hypertension). One of its primary therapeutic effects is the reduction of blood pressure. By blocking beta-adrenergic receptors, metoprolol decreases the heart rate and the force of contraction, leading to lower blood pressure.

Choice B reason:

While metoprolol can help manage certain types of dysrhythmias by slowing the heart rate and stabilizing the heart’s rhythm, the primary therapeutic effect for which it is most commonly prescribed is the reduction of blood pressure.

Choice C reason:

Increased urine output is not a direct therapeutic effect of metoprolol. This effect is more commonly associated with diuretics, which are often used in conjunction with beta-blockers to manage hypertension and heart failure.

Choice D reason:

Decreased pulse is a potential effect of metoprolol, as it slows the heart rate. However, this is not the primary therapeutic goal. The main therapeutic effect is the reduction of blood pressure.