A nurse is caring for a client who has hyperkalemia and is to receive intravenous insulin. Which of the following should the nurse recognize as an adverse outcome?

Serum potassium 4.8 mmol/l

Serum glucose 58 mg/d

Serum sodium 138 mEq/L

Calcium level of 100 mg

Answer and Explanation

The Correct Answer is B

A. Serum potassium 4.8 mmol/L: This is a normal potassium level (3.5–5.0 mmol/L) and indicates successful treatment.

B. Serum glucose 58 mg/dL: IV insulin drives potassium into cells, lowering serum potassium. However, insulin also lowers blood glucose, which can lead to hypoglycemia (glucose <70 mg/dL). Hypoglycemia is the primary adverse effect of IV insulin therapy.

C. Serum sodium 138 mEq/L: This is a normal sodium level (135–145 mEq/L) and not an adverse effect.

D. Calcium level of 100 mg: Calcium is not directly affected by IV insulin therapy.

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Correct Answer is A

Explanation

A. Prepare the client for dialysis: A potassium level of 8.3 mEq/L is critically high (normal range: 3.5–5.3 mEq/L), putting the client at immediate risk for life-threatening cardiac arrhythmias (e.g., ventricular fibrillation). Emergency dialysis is needed to remove excess potassium if other interventions (e.g., insulin, calcium gluconate) fail.

B. Start an IV and run normal saline at 50mL/hour: Fluid administration alone does not lower potassium quickly enough in a life-threatening situation.

C. Repeat the electrolyte values later in the day: Delaying treatment would increase the risk of cardiac arrest.

D. Monitor urine output: Although important, monitoring alone does not treat the emergency. Clients with acute renal failure often have little to no urine output.

A. " I can’t wait to start back to work next week, I really need the money.” B. "I will follow my 1.500 mL fluid restriction." C. "I will take my temperature and if it is above 101 I will call my doctor." D. "I am glad I won't have to keep track of how much I urinate in the day.”

Correct Answer is C

Explanation

A. "I can’t wait to start back to work next week, I really need the money." Returning to work too soon increases the risk of infection and complications. Clients should follow their provider's recommendations.

B. "I will follow my 1,500 mL fluid restriction." After a kidney transplant, patients typically need increased fluid intake to maintain kidney perfusion, not restriction.

C. "I will take my temperature and if it is above 101°F, I will call my doctor." Fever >101°F (38.3°C) is an early sign of infection or organ rejection. Prompt medical attention is required.

D. "I am glad I won't have to keep track of how much I urinate in the day." Clients must monitor urine output to detect signs of kidney rejection or dysfunction.

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A nurse is caring for a client who has hyperkalemia and is to receive intravenous insulin. Which of the following should the nurse recognize as an adverse outcome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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