The nurse is caring for a patient with hyperkalemia.
Which of the following interventions would be appropriate?
Encouraging the patient to consume a high-potassium diet.
Administering intravenous insulin and glucose.
Administering a potassium-sparing diuretic.
Encouraging the patient to limit fluid intake.
The Correct Answer is B
This is because hyperkalemia is a condition where the blood potassium level is too high.
This can cause cardiac arrhythmias, muscle weakness, and paralysis. Therefore, the nurse should administer intravenous insulin and glucose to lower the blood potassium level by shifting it into the cells.
Choice A is wrong because encouraging the patient to consume a high- potassium diet would increase the blood potassium level and worsen the condition.
Choice C is wrong because administering a potassium-sparing diuretic would prevent the excretion of excess potassium and aggravate the hyperkalemia.
Choice D is wrong because encouraging the patient to limit fluid intake is not relevant to the management of hyperkalemia and may cause dehydration.
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Related Questions
Correct Answer is D
Explanation
Monitoring the client’s electrolyte levels before and after the treatment. This is because acute kidney injury (AKI) can cause electrolyte imbalances such as hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis. Hemodialysis can help correct these imbalances by removing excess fluid and waste products from the blood. However, hemodialysis can also cause electrolyte shifts and complications such as hypotension, muscle cramps, and arrhythmias. Therefore, it is important to monitor the client’s electrolyte levels before and after the treatment to assess the effectiveness and safety of hemodialysis.
Choice A is wrong because monitoring the client’s blood pressure every 4 hours is not frequent enough during hemodialysis.
Hemodialysis can cause rapid changes in blood pressure due to fluid removal and vascular access.
Therefore, blood pressure should be monitored more often, such as every 15 to 30 minutes during hemodialysis.
Choice B is wrong because administering a loop diuretic before the treatment is not indicated for AKI patients receiving hemodialysis.
Loop diuretics are used to increase urine output and reduce fluid overload in AKI patients who have some residual kidney function.
However, hemodialysis can achieve the same goal by removing excess fluid from the blood.
Moreover, loop diuretics can cause electrolyte depletion and ototoxicity, which can worsen the condition of AKI patients.
Choice C is wrong because assessing the client’s respiratory status every 2 hours is not specific enough for hemodialysis treatment.
Hemodialysis can affect respiratory mechanics by altering fluid balance, acid- base status, and oxygen delivery.
Therefore, respiratory status should be assessed more frequently and comprehensively during hemodialysis, such as by measuring respiratory rate, oxygen saturation, arterial blood gas, and chest auscultation.
Correct Answer is C
Explanation
A urinary tract infection (UTI) is a common complication after bladder cancer surgery, especially if the patient has an indwelling urinary catheter.
A UTI can cause symptoms such as fever, pain, burning or urgency when urinating, blood in the urine, or cloudy or foul-smelling urine.
Choice A is wrong because urinary retention (the inability to empty the bladder completely) is unlikely to occur with an indwelling catheter, which drains urine continuously.
Choice B is wrong because urinary incontinence (the loss of bladder control) is more likely to occur after partial or radical cystectomy, which remove part or all of the bladder, respectively.
In these cases, reconstructive surgery is needed to create a new way for urine to leave the body.
Choice D is wrong because urinary urgency (the sudden and strong need to urinate) is also more likely to occur after partial or radical cystectomy, which can affect the nerves and muscles that control urination.
Urinary urgency can also be a symptom of a UTI, but it’s not the only one.
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