A nurse is caring for a client who has a hyperkalemia and is receiving insulin therapy. Which of the following should the nurse recognize as an adverse outcome?
Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L)
Serum sodium 138 mEq/L (136 to 145 mEq/L)
Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL)
Serum glucose 58 mg/dL (74 to 106 mg/dL)
The Correct Answer is D
A. Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L): A normal potassium level suggests effective treatment of hyperkalemia.
B. Serum sodium 138 mEq/L (136 to 145 mEq/L): This is within the normal sodium range and unrelated to the adverse effects of insulin therapy.
C. Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL): This is within the normal calcium range, unaffected by insulin therapy for hyperkalemia.
D. Serum glucose 58 mg/dL (74 to 106 mg/dL): Hypoglycemia is a potential adverse effect of insulin therapy because insulin drives glucose into cells, lowering blood sugar.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Serum potassium 4.8 mEq/L (3.5 to 5.0 mEq/L): A normal potassium level suggests effective treatment of hyperkalemia.
B. Serum sodium 138 mEq/L (136 to 145 mEq/L): This is within the normal sodium range and unrelated to the adverse effects of insulin therapy.
C. Calcium level of 10.0 mg/dL (9.0 to 10.5 mg/dL): This is within the normal calcium range, unaffected by insulin therapy for hyperkalemia.
D. Serum glucose 58 mg/dL (74 to 106 mg/dL): Hypoglycemia is a potential adverse effect of insulin therapy because insulin drives glucose into cells, lowering blood sugar.
Correct Answer is C
Explanation
A. Give the client 15 to 20 g of carbohydrate: While administering a carbohydrate source is appropriate to treat hypoglycemia, the nurse should first confirm whether the client is experiencing hypoglycemia by checking their blood glucose level.
B. Notify the nurse manager: Reporting the error is important but not the priority. The client's safety takes precedence over reporting.
C. Check the client's blood glucose level: This is the priority action to determine if hypoglycemia has occurred due to the incorrect insulin dose. Immediate identification of hypoglycemia ensures timely treatment.
D. Complete an incident report: Incident reports are essential for documenting errors, but they are a secondary step after ensuring the client's safety.
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