A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?
Suggest that the client use a salt substitute.
Advise the client to add citrus juices and bananas to her diet.
Obtain a 12-lead ECG
Obtain a blood sample for a serum sodium level
The Correct Answer is C
Rationale:
A. Salt substitutes often contain potassium and should be avoided in clients with hyperkalemia.
B. Citrus juices and bananas are high in potassium and should be avoided in clients with hyperkalemia.
C. A 12-lead ECG may include changes such as peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration.
D. A serum sodium level should be obtained but it is not the priority in this case.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. Reducing blood pressure until the patient is asymptomatic is not specific and may not be achievable or safe.
B. Reducing the blood pressure to normal over a period of hours may be too slow for a hypertensive emergency.
C. Reducing blood pressure to normal over a period of days is too slow for a hypertensive emergency.
D. The goal in a hypertensive emergency is to reduce blood pressure by 25% to 30% within the first hour, with the ultimate goal of a reduction of 50% in the first hour.
Correct Answer is A
Explanation
Rationale:
A. Swelling at the insertion site and cool extremity may indicate bleeding or hematoma formation at the site.
B. Oozing blood from the insertion site is expected immediately after a cardiac catheterization.
C. The client has not voided since returning to recovery is not related to the cardiac catheterization.
D. Blood pressure reading of 110/70 and heart rate of 90 are within normal limits.
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