Question

A nurse is planning care for a client who has chronic kidney disease and a potassium level of 7.3 mEq/L. Which of the following interventions should the nurse plan to take?

A) Initiate an IV infusion of lactated Ringer's solution.
B) Give spironolactone 50 mg PO BID.
C) Infuse regular insulin in dextrose 10% in water.
D) Administer supplemental phosphorus.

Answer 1

For a client with chronic kidney disease and a high potassium level of 7.3 mEq/L, the best intervention is to infuse regular insulin in dextrose 10% in water to lower the potassium level quickly and avoid cardiac complications.

Step-by-step explanation:

A nurse planning care for a client with chronic kidney disease and a potassium level of 7.3 mEq/L should consider intervention options carefully due to the risk associated with hyperkalemia. A potassium level of 7.3 mEq/L is considered to be significantly elevated (normal serum potassium levels are typically between 3.5 and 5.0 mEq/L), and hyperkalemia can lead to dangerous cardiac dysrhythmias.

Among the given options, the most immediate and appropriate intervention to lower potassium acutely would be option C) Infuse regular insulin in dextrose 10% in water. Insulin facilitates the uptake of glucose into the cells, and potassium follows the glucose, thereby lowering serum potassium levels temporarily. This treatment is often used in emergency situations to quickly reduce potassium levels while other longer-term treatments take effect.

Option A) is not suitable because lactated Ringer's solution contains potassium, which would exacerbate the hyperkalemia. Option B) entails administration of spironolactone, a potassium-sparing diuretic, which is inappropriate in the setting of hyperkalemia as it could potentially lead to an even higher potassium level. Option D) is inappropriate as well because phosphorus supplementation is not indicated in this scenario and does not address the hyperkalemia.