The client's laboratory results indicate that the serum potassium level is 2.5 mEq/L (2.5 mmol/L). Which action should the nurse take?
Reference Range: Potassium (K+) [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
Prepare to administer a glucose, then insulin, then potassium infusion.
Instruct the client to increase daily intake of potassium rich foods.
Inform the healthcare provider of the need for potassium replacement.
Change the plan of care to include hourly urinary output measurements.
Change the plan of care to include hourly urinary output measurements.
The Correct Answer is C
Rationale:
A. The combination of glucose and insulin is used to shift potassium into cells, which would lower serum potassium levels further; this is not appropriate for treating hypokalemia.
B. Increasing dietary intake of potassium is important but not sufficient to correct a serum potassium level as low as 2.5 mEq/L, which requires more immediate intervention.
C. A potassium level of 2.5 mEq/L is critically low and can lead to life-threatening cardiac arrhythmias. The healthcare provider should be informed immediately to initiate potassium replacement therapy, likely via intravenous infusion.
D. Hourly urinary output measurements may be useful but are not the immediate priority in treating severe hypokalemia.
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Correct Answer is B
Explanation
Rationale:
A. Administering an antianxiolytic might be premature and should only be done if prescribed and necessary.
B. Allowing the client to rest before taking vital signs helps ensure that the measurements are accurate and not influenced by recent emotional distress.
C. Notifying the client representative might be relevant later, but addressing the client's immediate needs and emotional state is the priority.
D. Offering hot tea may not be appropriate in this situation and does not directly address the need for accurate vital signs.
Correct Answer is B
Explanation
Rationale:
A. Insulin requirements generally increase as pregnancy progresses due to the growing placenta and hormones that cause insulin resistance, not fluctuate significantly.
B. Insulin requirements typically begin to increase around 18 weeks of gestation and continue to rise until approximately 36 weeks due to increased insulin resistance caused by placental hormones.
C. While insulin needs do increase, they do not typically double or quadruple during the second trimester. The increase is more gradual.
D. Insulin requirements increase during pregnancy and may decrease after delivery as the placenta is no longer present, removing the source of insulin resistance.