The nurse is caring for the client with cardiac and renal disease. The client now has a serum potassium level of 6.0 mEq/L. Which medications, if prescribed, should the nurse administer? Select all that apply.
Calcium gluconate 1.5 grams IV now
Dextrose 50% injection (50ml) IV push now
Colace 100 mg PO now
Regular insulin 10 units IV now
Potassium chloride 20 mEq orally now
Correct Answer : A,B,D
A) Calcium gluconate 1.5 grams IV now: Calcium gluconate is administered to counteract the effects of hyperkalemia by stabilizing the myocardial cell membrane. It does not lower potassium levels but helps protect the heart from potential dysrhythmias associated with high potassium levels.
B) Dextrose 50% injection (50ml) IV push now: Dextrose 50% injection, also known as D50W, is administered to temporarily shift potassium from the extracellular space into the intracellular space, thereby lowering serum potassium levels. It is commonly used in combination with insulin to facilitate the movement of potassium into cells.
C) Colace 100 mg PO now: Colace is a stool softener and does not affect serum potassium levels. It is not indicated for the treatment of hyperkalemia.
D) Regular insulin 10 units IV now: Regular insulin is administered with dextrose to facilitate the movement of potassium from the extracellular space into the intracellular space. Insulin stimulates the cellular uptake of glucose, which in turn drives potassium into cells along with glucose.
E) Potassium chloride 20 mEq orally now: Potassium chloride is contraindicated in the treatment of hyperkalemia as it would further increase serum potassium levels. It is typically used to supplement potassium in clients with hypokalemia, not hyperkalemia.
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Related Questions
Correct Answer is D
Explanation
A. Increased blood pressure:
In hypovolemia, the body experiences a significant loss of blood volume, which leads to a reduction in the amount of blood available to circulate through the vessels. This causes a drop in blood pressure, known as hypotension, rather than an increase. The body tries to compensate for the lower blood volume by constricting blood vessels and increasing heart rate, but this typically isn't sufficient to increase blood pressure to normal levels.
B. Decreased heart rate:
The body's natural response to hypovolemia includes an increase in heart rate, known as tachycardia, as the heart attempts to pump the remaining blood more efficiently to vital organs. This compensatory mechanism aims to maintain cardiac output despite the decreased blood volume.
C. Dyspnea:
Dyspnea, or difficulty breathing, can occur in many medical conditions, including heart failure and respiratory issues. While it can be seen in severe cases of hypovolemia, particularly if the condition leads to shock and subsequent multi-organ failure, it is not a primary or specific sign of hypovolemia.
D. Weak pulse:
A weak pulse is a primary and direct manifestation of hypovolemia. Due to the reduced volume of circulating blood, the heart has less blood to pump with each contraction, leading to a weaker pulse. This symptom indicates a decreased perfusion pressure, which is characteristic of hypovolemia. The body's compensatory mechanisms include vasoconstriction and an increased heart rate, but these measures often result in a pulse that is rapid but weak.
Correct Answer is D
Explanation
A. Light-headedness when standing up:
Elevated potassium levels (hyperkalemia) can lead to muscle weakness or paralysis, cardiac dysrhythmias, and even cardiac arrest. Light-headedness when standing up is more commonly associated with orthostatic hypotension or volume depletion rather than electrolyte imbalances like hyperkalemia.
B. Weak quadriceps muscles:
Weakness in the quadriceps muscles is not typically associated with the electrolyte imbalances presented in the scenario. Hyperkalemia can cause muscle weakness, but it is not specific to the quadriceps.
C. Decreased deep tendon reflexes:
Decreased deep tendon reflexes are not typically associated with the electrolyte imbalances presented in the scenario. Hyperkalemia can lead to hyperreflexia or absent reflexes, but it is not specific to decreased deep tendon reflexes.
D. Tingling of extremities:
This is the correct answer. Hypocalcemia, indicated by the low calcium level in the scenario, can manifest with symptoms such as tingling or numbness of the extremities, muscle cramps, and tetany. Calcium plays a crucial role in nerve transmission, and low levels can lead to sensory disturbances like tingling in the extremities.
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