Nurs 300 - Potassium Balance and Imbalances
A postoperative client with a serum potassium level of 3.6 mEq/L is ordered to receive an IV with a potassium supplement (KCl) via a peripheral line. The nurse checks to determine that the amount of KCl ordered does not exceed the standard hourly replacement rate of ____ mEq/hr. Record your answer rounding to the nearest whole number.
*10 mEq/hr* *Rationale:* The maximum routine rate of infusion for KCl is 10 mEq/hr (may range from 5-10) via infusion pump. Clients who are moderately hypokalemic may have potassium administered at a rate of 10-20 mEq/hr, but this client is not moderately hypokalemic. Higher concentrations of potassium can be administered via a central line in critically ill clients who are hemodynamically monitored.
The nurse should include dietary teaching regarding addition of potassium-rich foods if the client is receiving which diuretic? Select all that apply. A. Hydrochlorothiazide (HCTZ) B. Sprionolactone (Aldactone) C. Triamterene with hydrochlorothiazide (Maxide) D. Amiloride (Midamor) E. Furosemide (Lasix)
*A, E* *Rationale:* HCTZ and Lasix are diuretics that increase the excretion of potassium, so clients should be taught to increase the intake of potassium in their diet. All other medications are considered potassium-sparing or combination diuretics and, as such, dietary supplementation would not be indicated.
Which serum potassium level would the nurse anticipate seeing in a child with a three-day history of diarrhea? A. 3.0 mEq/L B. 3.6 mEq/L C. 4.1 mEq/L D. 5.8 mEq/L
*A. 3.0 mEq/L* *Rationale:* A client who has diarrhea will be more likely to develop hypokalemia. A serum potassium of 3.0 mEq/L is considered to be hypokalemic. A level of 3.6 mEq/L is just within the normal range but one would expect a greater K+ loss given the client's history of three dye of diarrhea. A level of 4.1 mEq/L is within the normal range and does not reflect potassium loss. A level of 5.8 mEq/L reflects hyperkalemia
The nurse anticipates the client with which condition would be at most risk to develop hyperkalemia? A. Chronic renal failure B. Newly diagnosed cirrhosis C. Partial bowel obstruction requiring nasogastric suctioning D. Diarrhea for the last four days
*A. Chronic renal failure* *Rationale:* Client in renal failure have difficulty excreting potassium, leading to its accumulation in the bloodstream. Client with cirrhosis tend to retain sodium and lose potassium, which would contribute to hypokalemia. Intestinal and nasogastric suctioning lead to the loss of potassium and hypokalemia. Potassium is lost with diarrhea, leading to hypokalemia.
The nurse instructs a client receiving hydrochlorothiazide (HCTZ) to report which of the following symptoms to the health care provider? A. Leg cramps and muscle weakness B. Muscle weakness and diarrhea C. Fatigue and irritability D. Nausea and irritability
*A. Leg cramps and muscle weakness* *Rationale:* HCTZ is a potassium-wasting diuretic, and its use can lead to hypokalemia. Leg cramps and muscle weakness are two of the symptoms seen in a client with hypokalemia. Diarrhea, fatigue nausea, and irritability are not usually seen with the use of this class of diuretics.
The nurse should place highest priority on which nursing intervention for a client with renal failure who has a potassium level of 6.8 mEq/L? A. Obtain an electrocardiogram (ECG) B. Evaluate level of consciousness C. Measure urinary output D. Draw arterial blood gases
*A. Obtain an electrocardiogram (ECG)* *Rationale:* A potassium level of 6.8 mEq/L is a critically high potassium level and could cause life-threatening cardiac arrhythmias; an ECG should be obtained. Although the client's level of consciousness may be affected by the hyperkalemia and decreased cardiac output, this is not of highest priority. The client with renal failure has a decreased urinary output that needs to be measured, but this is not the most critical nursing intervention wight this critically high potassium level. Arterial blood gases may be indicated to determine state of acidosis and respiratory status, but is not a greater priority than obtaining an ECG.
The nurse identifies which of the following clients admitted to the hospital to be at risk for developing hypokalemia? Select all that apply. A. A client whose arterial blood gases indicate metabolic acidosis B. A client who had developed metabolic alkalosis C. A client with acute renal failure D. A client with adult respiratory distress syndrome (ARDS) E. The client with a nasogastric tube to low intermittent suction
*B, E* *Rationale:* A client with metabolic alkalosis is at risk for developing hypokalemia due to the shift of potassium to the ICF from the ECF. Clients with NG tube lose potassium from the stomach and the NPO status limits their intake. Clients with acute renal failure are usually hyperkalemic due to a decreased ability to excrete potassium. Clients with ARDS are usually hyperkalemic due to compromised ventilation, resulting in metabolic acidosis. Metabolic acidosis is associated with hyperkalemia because potassium shifts from the ECF to the ICK as a result of increase in hydrogen ion concentration.
Which of the following statements by a client indicates a need for further instruction regarding treatment of hypokalemia? A. "I will eat more bananas and cataloupes for breakfast." B. "I will eat more bran flakes to increase my potassium level." C. "I will take my potassium in the morning after breakfast so it does not upset my stomach." D. "I will tell my primary care provider if I start having muscle cramps or weakness."
*B. "I will eat more bran flakes to increase my potassium level." *Rationale:* Bran flakes are not a source of potassium in the diet. It is important for the client to communicate to the physician if symptoms of hypokalemia develop during the course of therapy. Bananas and cantaloupe are excellent sources of dietary potassium. Taking potassium supplements on a full stomach will help to minimize gastric irritation, which is commonly associated with this medication.
The nurse is instructing a client diagnosed with hyperkalemia about foods to avoid. Which of the following statements by the client indicates to the nurse a need for further instruction? A. "I should avoid eating a lot of bananas." B. "It will be nice to be able to eat a lot of fresh tomatoes this summer." C. "I will avoid using salt substitutes instead of real salt." D. "No more avocado salads for me."
*B. "It will be nice to be able to eat a lot of fresh tomatoes this summer."* *Rationale:* Bananas, tomatoes, avocados, and salt substitutes are all high in potassium and should be limited in a client with hyperkalemia. Clients should be aware of foods to avoid that are high in potassium if teaching has been successful.
Which of the following foods should the nurse instruct the client with end stage renal disease (ESRD) to avoid? A. Bread B. Cantaloupe C. Green beans D. Apple juice
*B. Cantaloupe* *Rationale:* Clients with ESRD are unable to excrete potassium and need to restrict intake of foods high in potassium. Cantaloupes are very high in potassium and should be avoided. Bread, green beans, and apple juice are not considered to be good sources of potassium. These foods do not need to be restricted in the diet.
When caring for a client who has a potassium level of 2.8 mEq/L, the nurse should assess for which of the following? A. Perforated bowel B. Paralytic ileus C. Renal failure D. Diabetes mellitus
*B. Paralytic ileus* *Rationale:* Hypokalemia can lead to alterations in smooth muscle functioning. Smooth muscle alteration in the gastrointestinal tract can lead to development of a paralytic ileum. Complications of hypokalemia are usually not associated with renal failure, diabetes, or a perforated bowel because these conditions are more likely to lead to increased potassium levels.
The nurse provides which instruction to a client getting home with a prescription for spironolactone (Aldactone)? A. "Be sure to take this medication on an empty stomach." B. "Take this pill just before you go to bed." C. "Cut back on your intake of those foods on your list that are high in potassium." D. "You do not have to watch your intake of fluid while you are taking this medicine."
*C. "Cut back on your intake of those foods on your list that are high in potassium."* *Rationale:* Aldactone is a potassium-sparing diuretic and the intake of potassium-rich foods should be discouraged. Diuretics should not be taken before going to bed because their primary effect is diuresis. The time frame could cause the client to experience altered sleep patterns due to nocturia. Clients taking diuretics should be aware of their fluid intake and monitor accordingly.
The nurse concludes that a client understands the side effects of furosemide (Lasix) and its relationship to potassium levels when the client makes which statement? A. "I do not need to take my pulse anymore when I take my Digoxin." B. "I should call the doctor if I develop diarrhea." C. "I should call my doctor if I feel myself becoming dizzy when I stand up." D. "I do not need to eat bananas for breakfast any more because I am taking this medication."
*C. "I should call my doctor if I feel myself becoming dizzy when I stand up."* *Rationale:* Lasix is a potassium-wasting diuretic that can cause the client to become hypokalemic. This can manifest as a weak, thready pulse and onset of orthostatic hypotension. Diarrhea is not usually seen as a side effect of medication. Monitoring of one's pulse is not required for clients taking digoxin or who have a pacemaker. Bananas are a good source of dietary potassium and may be warranted for this client in order to maintain normal serum potassium levels.
Which statement should the nurse include when teaching a client about oral potassium supplementation? A. "When you take your potassium pill, if you can now swallow it, you can crush it up and put it in orange juice." B. "Potassium should only be taken in the morning on an empty stomach." C. "Take your potassium tablet after you have eaten your breakfast." D. "You can continue to use a salt substitute while you are taking your potassium supplement."
*C. "Take your potassium tablet after you have eaten your breakfast."* *Rationale:* Potassium can irritate the stomach and should be taken just after eating. Many potassium supplants are time released and should not be crushed. To prevent gastric irritation, oral potassium supplements should be taken with at least four ounces of fluid or with food. Salt substitutes may contain potassium and, if take with a potassium supplement, could cause hyperkalemia.
What is the best response by the nurse to the 22-year-old daughter of a 56-year-old client admitted with hypokalemia and who reports being dizzy upon standing? A. "Your mother has been lying in bed too long and when she stands up she will get dizzy." B. "Once we correct your mother's potassium level, the sissiness should improve." C. "Your mother is probably dizzy because her heart is not pumping as effectively, making her blood pressure low." D. "Your mother is dizzy because her nervous system is not functioning correctly; once her potassium level goes up, she will improve."
*C. "Your mother is probably dizzy because her heart is not pumping as effectively, making her blood pressure low."* *Rationale:* Potassium works to maintain cardiac contractility and normal heart rate. Hypokalemia leads to the development of potential arrhythmias that can result in ischemia and death. While the length of bed rest and actual potassium level could be associated with a complaint of dizziness, it is more likely that the dizziness is associated with orthostatic hypotension and inefficient heart pumping action due to hypokalemia. It is important for the client (and family) to understand that electrolyte imbalances may have significant complications that can affect the entire body.
The nurse determines that the intravenous (IV) administration of calcium gluconate to a client with hyperkalemia has been effective when which finding is seen on assessment? A. Urine output increases B. Bowel movements are loose C. Cardiac dysrhythmia is corrected D. Muscles are relaxed and weak
*C. Cardiac dysrhythmia is corrected* *Rationale:* Calcium gluconate is given to antagonize the effects of potassium on the conduction system of the heart. It is not given to promote potassium excretion (either in urine or stool). The medication acts to blunt the effects of elevated potassium on the myocardium.
The nurse plans to administer which intravenous (IV) treatment to a client for treatment of hyperkalemia associated with severe acidosis? A. Calcium gluconate to make the potassium shift from intracellular fluid (ICF) to the extracellular fluid (ECF) B. Insulin and dextrose to make the client hypoglycemic C. Sodium bicarbonate to make the client alkalotic so the potassium will shift into the ICF D. Normal saline (NS) to provide extra sodium so the potassium will move out of the ICF into the ECF
*C. Sodium bicarbonate to make the client alkalotic so the potassium will shift into the ICF* *Rationale:* Sodium bicarbonate will temporarily alkalinize the plasma, causing the potassium to move into the cells. NS is an isotonic solution and therefor will not cause fluid or electrolyte shifting. Calcium gluconate is given to blunt the effects on the myocardium; it does not decrease the serum K+ level. Insulin and dextrose are given to decrease K+ levels by increasing K+ uptake at the cellular level.
Which of the following potassium levels would be of greatest concern to the nurse when seen in a client who is staking furosemide (Lasix)? A. 5.4 mEq/L B. 4.3 mEq/L C. 3.4 mEq/L D. 3.1 mEq/L
*D. 3.1 mEq/L* *Rationale:* Potassium is lost when taking a loop diuretic such as furosemide (Lasix); a level of 3.1 mEq/L is below the normal range of potassium and would be of greatest concern to the nurse. A potassium level of 5.4 mEq/L is elevated, reflecting retention of potassium. A potassium level of 4.3 mEq/L is within the normal range of potassium levels. A potassium level of 3.4 mEq/L is at the low end of the normal range of potassium levels and may be of concern to the nurse, but it does not reflect the level that is of most concern.
A client is admitted to the hospital with a serum potassium level of 2.8 mEq/L. The nurse anticipates that assessment findings will include which of the following? A. Elastic skin turgor and vomiting a small amount of bile-stained emesis B. Pink nail beds, and ECG showing normal sinus rhythm with a rate of 76 C. Respiratory rate of 16 with equal bilateral breath sounds, and two loose stools this morning D. Irregular pulse rate and shallow respirations
*D. Irregular pulse rate and shallow respirations* *Rationale:* A serum level of 2.8 mEq/L reflects hypokalemia, which often manifests as cardiac and respiratory problems related to the ineffective smooth muscle contractions. One option reflects normal findings. The symptoms listed in two other options do not indicate severe hypokalemia. A serum potassium of 2.8 mEq/L in conjunction with irregular pulse and shallow respirations is a symptomatic presentation in this client and suggests severe hypokalemia. It is important to look at the whole clinical picture and not just the serum level to determine the severity of an electrolyte imbalance.