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

Answer and Explanation

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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Correct Answer is A

Explanation

A. "It will be a change for you, but a normal lifestyle is still possible. What concerns you the most?": This response acknowledges the patient's feelings while offering reassurance that life can still be fulfilling after surgery. It also invites the patient to express their concerns, allowing the nurse to address specific worries and provide tailored support.

B. "How has your husband reacted to the news?": While understanding the patient's support system is important, this response does not directly address the patient's expressed feelings of disbelief and may not be the most immediate concern for the patient at this moment.

C. "Don't worry. Many patients have had this same surgery and learn to manage very well.": While meant to offer reassurance, this response may come across as dismissive of the patient's feelings of disbelief and anxiety about the upcoming surgery.

D. "You sound like you are in disbelief. Why do you feel this way?": This response acknowledges the patient's expressed emotion but may come across as confrontational or probing, potentially making the patient feel defensive. It's important to provide support and reassurance while inviting the patient to share their concerns in a non-threatening manner.

A. Increase hematocrit B. Increased temperature C. Increased heart rate D. Increased respiratory rate E. Increased blood pressure

Correct Answer is ["C","D","E"]

Explanation

A) Increase hematocrit: Fluid overload typically results in dilutional effects on the blood, leading to a decrease in hematocrit rather than an increase. Hematocrit levels may decrease due to the relative decrease in the concentration of red blood cells in relation to plasma.

B) Increased temperature: Fluid overload is not typically associated with an increase in body temperature. While fever can occur as a result of infection, it is not a direct manifestation of fluid overload.

C) Increased heart rate: Fluid overload can lead to increased blood volume, which results in an increased workload for the heart. As a compensatory mechanism, the heart rate may increase to maintain adequate cardiac output.

D) Increased respiratory rate: Fluid overload can cause pulmonary congestion and impair gas exchange in the lungs, leading to respiratory distress. As a result, the respiratory rate may increase as the body attempts to compensate for the decreased oxygenation.

E) Increased blood pressure: Fluid overload can lead to an increase in blood volume, which results in increased pressure within the blood vessels. As a result, blood pressure may rise as the heart works harder to pump the excess fluid throughout the body.

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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.

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