A nurse is caring for a client who is ordered Potassium 40 mEq IV. On hand is Potassium Chloride 20 mEq/mL. What is the nurse’s next action?

Mix potassium in 1 liter of normal saline.

Call the physician for order clarification.

Prepare 20 mEq of Potassium to give IV push.

Give the medication as ordered.

Answer and Explanation

The Correct Answer is B

A. While potassium is typically diluted in IV fluids, the concentration and infusion rate must be clarified before administration. A standard dilution is 10 mEq in 100 mL or 40 mEq in 1L, but this must be verified.
B. Calling the physician for clarification is the safest step. IV potassium should never be given undiluted or as an IV push due to the risk of fatal cardiac arrhythmias.
C. IV push potassium is never appropriate as it can cause cardiac arrest.
D. Administering the undiluted 20 mEq/mL solution is dangerous and requires proper dilution before administration.

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Correct Answer is B

Explanation

A. Amiodarone is an antiarrhythmic medication used after defibrillation and CPR in persistent ventricular fibrillation (VF) or ventricular tachycardia (VT). However, it is not the first priority.
B. Defibrillation is the immediate priority in a pulseless client with ventricular fibrillation. Early defibrillation increases the chances of survival. The shock should be delivered as soon as possible.
C. Epinephrine is given after the first defibrillation and CPR cycle, not before.
D. Synchronized cardioversion is inappropriate because it is used for unstable tachyarrhythmias with a pulse, not pulseless VF.

A. "Cardiac Rehab will help you get back to normal." B. "The cardiac rehab program can help you safely return to an active lifestyle." C. "It's normal to feel that way at first, but once you learn the routine, you'll enjoy it." D. "Your doctor is the expert and would only recommend what is best for you."

Correct Answer is B

Explanation

A. While cardiac rehab does help recovery, this statement does not emphasize the safety and long-term benefits of supervised rehabilitation.
B. Providing education about the role of cardiac rehab is essential. Cardiac rehab monitors the client's progress and helps safely return them to an active lifestyle.
C. While this statement acknowledges the client's feelings, it does not provide enough information about the benefits of cardiac rehab.
D. This response is too authoritative and does not address the client’s concerns or autonomy.

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A nurse is caring for a client who is ordered Potassium 40 mEq IV. On hand is Potassium Chloride 20 mEq/mL. What is the nurse’s next action?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with chest pain who becomes unresponsive. The client is pulseless and apneic. The code team places the client on the monitor, which indicates ventricular fibrillation. What is the next priority action?

Correct Answer is B

Explanation

A nurse is caring for a client post-transcatheter aortic valve replacement (TAVR). During the first cardiac rehabilitation session, the client tells the nurse, "I do not need to be here. I am feeling so much better, I can do this at home." Which of the following is the appropriate nursing response?

Correct Answer is B

Explanation

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