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Question

Difficulty: MediumReduction of Risk Potential

A nurse is evaluating a client with acute kidney injury who is receiving a prescribed continuous intravenous infusion of regular insulin and 50% dextrose in water. To minimize the risk of a severe physiological complication, which of the following assessment findings demands the most immediate intervention by the nurse?

  1. The cardiac monitor displays new development of prominent U waves and flattened T waves.Answer
  2. B
    Arterial blood gas results reveal a pH of 7.31, PaCO2PaCO_2 of 35 mm Hg, and HCO3−HCO_3^- of 16 mEq/L.
  3. C
    The client's blood pressure decreases from 145/88 mm Hg to 135/82 mm Hg over a two-hour period.
  4. D
    The client is resting in a left lateral decubitus position while the intravenous infusion is administered.

Answer

The development of prominent U waves and flattened T waves on the cardiac monitor requires immediate intervention.
Intravenous regular insulin administered with dextrose is a standard treatment to temporarily shift potassium from the extracellular space into the intracellular space, effectively reducing serum potassium levels. A primary risk of this therapy is a severe overcorrection leading to hypokalemia. The presence of prominent U waves and flattened T waves on an electrocardiogram are classic physiological indicators of hypokalemia, which can rapidly degenerate into life-threatening ventricular arrhythmias. This finding demands immediate cessation of the infusion, serum electrolyte verification, and notification of the healthcare provider to reduce the risk of a potential cardiac event.

Step-by-Step Solution

1
Analyze the prescribed therapy and its physiological purpose.
The client is receiving regular insulin and 50% dextrose in water, which is a treatment used to lower serum potassium levels by shifting potassium from the extracellular space into the cells.
Understanding the mechanism of action is necessary to anticipate potential adverse effects and complications.
2
Evaluate the clinical findings in the options against the risks of the therapy.
The therapy risks lowering the potassium level too much (hypokalemia). Prominent U waves and flattened T waves are classic ECG signs of hypokalemia.
Connecting the treatment risk to the assessment findings identifies the most critical complication.
3
Prioritize the assessment findings based on immediate threat to life.
A new cardiac arrhythmia risk (hypokalemia) supersedes expected metabolic acidosis, normal vital sign variations, and safe client positioning.
Prioritization requires addressing airway, breathing, and circulation (arrhythmia) before expected chronic baseline findings.

Key Concept

Monitoring for and mitigating life-threatening hypokalemia during intravenous insulin and dextrose administration.
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Reduction of Risk Potential

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