The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.
Sodium bicarbonate
Albuterol
Kayexalate
Metoprolol (Lopressor)
E. Insulin & dextrose
F. Calcium Gluconate
Correct Answer : B,C,E,F
The correct answers are B, C, E, and F.
Rationale for each choice:
- Albuterol
Mechanism of action: Albuterol is a beta-2 agonist that stimulates beta-2 receptors in the cell membranes of skeletal muscle, liver, and adipose tissue. This stimulation causes an increase in intracellular cyclic AMP (cAMP), which activates protein kinase A (PKA). PKA then phosphorylates a number of proteins, including the sodium-potassium ATPase pump. This pump is responsible for transporting potassium ions into cells and out of the bloodstream. By increasing the activity of this pump, albuterol can help to lower serum potassium levels.
Onset of action: Albuterol has a rapid onset of action, typically within 30 minutes.
Duration of action: The duration of action of albuterol is relatively short, usually 4-6 hours.
Dosage: The dosage of albuterol for hyperkalemia is typically 10-20 mg nebulized every 4-6 hours.
Additional considerations: Albuterol can cause tachycardia and tremors. It should be used cautiously in patients with heart disease or hyperthyroidism.
- Kayexalate
Mechanism of action: Kayexalate is a cation exchange resin that binds to potassium ions in the gastrointestinal tract. This prevents the potassium from being absorbed into the bloodstream.
Onset of action: Kayexalate has a relatively slow onset of action, usually 1-2 hours.
Duration of action: The duration of action of Kayexalate is relatively long, usually 4-6 hours.
Dosage: The dosage of Kayexalate for hyperkalemia is typically 15-30 grams orally or rectally every 6 hours.
Additional considerations: Kayexalate can cause constipation and hypocalcemia. It should be used cautiously in patients with bowel obstruction or kidney disease.
- Insulin & dextrose
Mechanism of action: Insulin promotes the movement of potassium into cells, thus lowering serum potassium levels. Dextrose is given along with insulin to prevent hypoglycemia.
Onset of action: Insulin has a rapid onset of action, typically within 30 minutes.
Duration of action: The duration of action of insulin is relatively short, usually 4-6 hours.
Dosage: The dosage of insulin for hyperkalemia is typically 10 units of regular insulin IV push, followed by an infusion of 5-10 units per hour. The dosage of dextrose is typically 50 grams IV push, followed by an infusion of 10% dextrose at 100 mL/hour.
Additional considerations: Insulin can cause hypoglycemia. It should be used cautiously in patients with diabetes mellitus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Infertility is a common issue for women with endometriosis. The endometrial tissue that grows outside the uterus can cause scarring and inflammation, which can block fallopian tubes and prevent eggs from being released or fertilized. Studies have shown that 30-50% of women with endometriosis experience infertility.
It is important to address this potential issue with the patient and discuss options for fertility preservation if desired.
Choice B rationale:
There is no evidence to suggest that women with endometriosis are more likely to have multiples. The likelihood of having multiples is primarily influenced by factors such as genetics, maternal age, and the use of fertility treatments.
Choice C rationale:
Acetaminophen may not be effective for pain relief in women with endometriosis. The pain associated with endometriosis is often severe and can be unresponsive to over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often more effective in managing endometriosis-related pain.
In some cases, stronger pain medications such as opioids may be necessary.
Choice D rationale:
Oral contraceptives can be helpful for women with endometriosis by:
Suppressing ovulation, which can reduce the amount of endometrial tissue that grows and bleeds each month.
Thinning the uterine lining, which can also reduce pain and bleeding.
Slowing the growth of endometrial tissue.
Oral contraceptives are not a cure for endometriosis, but they can help to manage symptoms and improve quality of life.
Correct Answer is A
Explanation
Choice A rationale:
Amniocentesis is the most reliable and direct method to assess fetal lung maturity. It involves the extraction of a small sample of amniotic fluid from the amniotic sac, which surrounds the fetus in the uterus. This fluid contains various substances, including surfactant, which is a crucial substance produced by the fetal lungs that enables them to expand and function properly after birth.
By analyzing the levels of surfactant and other components in the amniotic fluid, clinicians can accurately determine the maturity of the fetal lungs. This information is essential in guiding decisions about potential delivery options, especially in cases of preterm labor or other complications that may necessitate early delivery.
Amniocentesis is generally considered a safe procedure, but it does carry some small risks, such as infection, bleeding, or amniotic fluid leakage. However, these risks are typically outweighed by the benefits of obtaining accurate information about fetal lung maturity when necessary.
Choice B rationale:
Fetal fibronectin (fFN) is a protein that is found in the amniotic fluid and cervicovaginal secretions. Elevated levels of fFN in cervicovaginal secretions between 22 and 34 weeks of gestation can indicate an increased risk of preterm labor.
However, fFN testing is not a direct measure of fetal lung maturity. It is used primarily as a screening tool to assess the risk of preterm birth, not to determine the readiness of the fetal lungs for delivery.
Choice C rationale:
Chorionic villus sampling (CVS) is a prenatal diagnostic test that involves taking a small sample of chorionic villi, which are tiny finger-like projections of placental tissue. This test is typically performed earlier in pregnancy (between 10 and 13 weeks gestation) to diagnose genetic abnormalities in the fetus.
CVS is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.
Choice D rationale:
Alpha-fetoprotein (AFP) is a protein produced by the fetal liver. Elevated levels of AFP in the maternal blood can indicate an increased risk of certain birth defects, such as neural tube defects.
AFP testing is not used to assess fetal lung maturity. It does not provide any information about the development of the fetal lungs or their readiness for birth.
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