A nurse is caring for a patient whose sodium level is 118 mEq/L. Which nursing diagnosis is a priority for this patient?

Choice A Reason: This is correct because sodium polystyrene sulfonate is a medication that binds to potassium in the gastrointestinal tract and removes it from the body through feces. Sodium polystyrene sulfonate is used to treat hyperkalemia, which is a high level of potassium in the blood. A serum potassium of 6.2 mEq/L indicates hyperkalemia, which can cause muscle weakness, cardiac arrhythmias, and cardiac arrest. The nurse should monitor the client's vital signs, electrocardiogram, and serum potassium level, and administer sodium polystyrene sulfonate as ordered.

Choice B Reason: This is incorrect because a potassium-sparing diuretic is a medication that prevents the loss of potassium in the urine and increases the excretion of sodium and water. A potassium-sparing diuretic is used to treat hypokalemia, which is a low level of potassium in the blood, not hyperkalemia. A potassium-sparing diuretic would worsen the client's condition by raising their serum potassium level even higher.

Choice C Reason: This is incorrect because initiating an IV potassium infusion is a dangerous and contraindicated intervention for a client who has hyperkalemia. IV potassium infusion is used to treat hypokalemia, not hyperkalemia. IV potassium infusion would increase the client's serum potassium level rapidly and put them at risk of fatal cardiac arrhythmias and cardiac arrest.

Choice D Reason: This is incorrect because encouraging the client to eat bananas is an inappropriate and harmful intervention for a client who has hyperkalemia. Bananas are a rich source of potassium, which is a mineral that is essential for nerve and muscle function, but can be toxic in excess. Bananas contain about 422 mg of potassium per medium-sized fruit, which is about 10% of the daily requirement for adults. The nurse should advise the client to avoid foods high in potassium, such as bananas, avocados, potatoes, tomatoes, and oranges.

Choice A Reason: This is incorrect because hypokalemia is a low level of potassium in the blood, which can cause muscle cramps, weakness, fatigue, and cardiac arrhythmias. Spironolactone is a potassium-sparing diuretic that prevents the loss of potassium in the urine and increases the excretion of sodium and water. Spironolactone can cause hyperkalemia, not hypokalemia, especially if taken with other medications or supplements that increase potassium levels.

Choice B Reason: This is incorrect because hypocalcemia is a low level of calcium in the blood, which can cause tetany, seizures, and cardiac arrhythmias. Spironolactone does not affect calcium levels significantly, and this result does not indicate an urgent problem for the patient.

Choice C Reason: This is incorrect because hyponatremia is a low level of sodium in the blood, which can cause confusion, seizures, and coma. Spironolactone can cause hyponatremia by increasing the excretion of sodium and water, but this result is not related to the patient's ECG changes or muscle weakness.

Choice D Reason: This is correct because hyperkalemia is a high level of potassium in the blood, which can cause muscle weakness, cardiac arrhythmias, and cardiac arrest. Spironolactone can cause hyperkalemia by preventing the loss of potassium in the urine and increasing the retention of potassium in the body. The nurse should monitor the patient's vital signs, electrocardiogram, and serum potassium level, and administer medications or dialysis as ordered.

Choice E Reason: This is incorrect because hypercalcemia is a high level of calcium in the blood, which can cause nausea, vomiting, constipation, and cardiac arrhythmias. Spironolactone does not affect calcium levels significantly, and this result does not indicate an urgent problem for the patient.