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Difficulty: HardReduction of Risk Potential

A practical nurse is reviewing clinical data for four assigned clients. Which client finding indicates the highest risk for a life-threatening complication and requires immediate communication to the registered nurse?

  1. A
    A client with type 2 diabetes and an infected leg wound whose morning fasting capillary blood glucose level is 182 mg/dL
  2. A client receiving scheduled nebulized albuterol and intravenous corticosteroids who reports new generalized muscle weakness and a sensation of skipped heartbeatsAnswer
  3. C
    A client with severe, localized abdominal pain who is requesting an immediate dose of prescribed intravenous push (IVP) morphine
  4. D
    A client with a history of essential hypertension whose morning vital signs include a blood pressure of 146/88 mm Hg and a heart rate of 82 beats/min

Answer

The client receiving albuterol and corticosteroids who reports new generalized muscle weakness and a sensation of skipped heartbeats is the priority.
Both albuterol (a beta-2 adrenergic agonist) and corticosteroids lower serum potassium levels. When administered together, the client is placed at high risk for severe hypokalemia. Symptoms such as profound muscle weakness and palpitations (a sensation of skipped heartbeats) strongly indicate a secondary cardiac arrhythmia. This represents an immediate threat to the client's life (Circulation in the ABCs) and requires emergency notification to the registered nurse for rapid medical intervention.

Step-by-Step Solution

1
Analyze the symptoms of the client receiving albuterol and corticosteroids.
The client is experiencing new generalized muscle weakness and skipped heartbeats.
Both albuterol and corticosteroids shift potassium intracellularly or increase its excretion. The combination creates a high risk for severe hypokalemia, which commonly presents as muscle weakness and palpitations, indicating a potentially lethal cardiac arrhythmia.
2
Evaluate the blood glucose level of the client with type 2 diabetes and an active infection.
The fasting capillary blood glucose is 182 mg/dL.
Infection triggers a physiological stress response that predictably elevates blood glucose levels. While abnormal, this is a stable, expected finding that can be managed routinely without an emergency escalation.
3
Assess the clinical priority of the client requesting intravenous push (IVP) morphine.
The client has severe pain requiring medication.
Pain is a critical psychosocial and comfort need, but it does not supersede a physiological airway, breathing, or circulation (ABC) emergency. Furthermore, IVP medications require RN administration and fall outside standard PN scope.
4
Interpret the vital signs of the client with essential hypertension.
Blood pressure is 146/88 mm Hg and heart rate is 82 beats/min.
These are borderline elevated but represent an expected baseline for a client with a history of hypertension, posing no acute or immediate physiological risk.

Key Concept

Prioritizing Acute Pharmacological Complications
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Topics

Reduction of Risk Potential

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