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Question

Difficulty: MediumReduction of Risk Potential

A practical nurse reviews the morning electronic health record for a client with end-stage renal disease who is awaiting their scheduled afternoon hemodialysis treatment. The client's serum potassium level is reported at 6.8 mEq/L (6.8 mmol/L). The client is currently resting quietly in bed and denies any physical distress. Which action should the practical nurse take first?

  1. Report the laboratory results to the registered nurse immediately for prompt medical evaluation.Answer
  2. B
    Document the elevated potassium level as an expected baseline finding prior to a dialysis treatment.
  3. C
    Direct the unlicensed assistive personnel to independently perform and interpret a 12-lead electrocardiogram.
  4. D
    Prioritize the assessment of the client's arteriovenous fistula site for a palpable thrill and audible bruit.

Answer

The correct action is to immediately report the critical laboratory results to the registered nurse so that prompt medical evaluation and emergency treatment can be initiated.
The correct answer addresses the immediate physiological threat. A potassium level of 6.8 mEq/L is critically high and severely alters myocardial cell depolarization. This places the client at imminent risk for ventricular fibrillation or cardiac arrest. The practical nurse must immediately notify the registered nurse so that emergency interventions can be initiated.

Step-by-Step Solution

1
Evaluate the reported laboratory value against normal reference ranges.
The client's serum potassium is 6.8 mEq/L. The normal reference range is 3.5 to 5.0 mEq/L.
Identifying abnormal laboratory values is the first step in recognizing potential physiological risks.
2
Analyze the clinical implications of the abnormal finding in the context of the client's condition.
Severe hyperkalemia (greater than 6.5 mEq/L) can cause fatal cardiac dysrhythmias, regardless of the client's lack of physical symptoms.
Understanding the severity of the complication guides prioritization.
3
Determine the appropriate scope of practice and escalation protocol.
The practical nurse must immediately notify the registered nurse or healthcare provider to initiate emergency treatment protocols.
Critical lab values that pose an immediate threat to life require rapid escalation outside the independent scope of the practical nurse.

Key Concept

Identifying and Escalating Critical Laboratory Values (Hyperkalemia)
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Topics

Reduction of Risk Potential

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