PNLE Nursing Practice II Fluid & Electrolyte Imbalances, IV Fluids & Potassium Safety (Topnotcher Rapid Cram Study System)

Hypokalemia vs Hyperkalemia & IV Potassium Protocol: POTASSIUM RULES (Normal 3.5 - 5.0 mEq/L): • HYPERKALEMIA (> 5.0): Peaked T waves, ST depression, muscle weakness, risk of asystole! Treatment: Calcium Gluconate (protects heart), Regular Insulin + D50W, Kayexalate, Albuterol. • HYPOKALEMIA (< 3.5): Flat T waves, U waves, PVCs, muscle cramps. Often caused by Loop Diuretics (Furosemide). CRITICAL SAFETY RULE: NEVER, EVER GIVE POTASSIUM CHLORIDE IV PUSH OR BOLUS! IT IS FATAL (LETHAL INJECTION)! Always dilute in IV bag with infusion pump, maximum rate 10-20 mEq/hr with continuous cardiac monitoring! ---------------------------------------- PRACTICE BOARD QUESTION & RATIONALE: Q: A client's serum potassium level is 6.2 mEq/L with ECG showing tall peaked T waves. Which medication should the nurse prepare to administer FIRST to prevent cardiac arrest? A. Sodium Polystyrene Sulfonate (Kayexalate) orally B. Calcium Gluconate 10% IV over 2 to 3 minutes C. Regular Insulin 10 units IV D. Furosemide (Lasix) 40 mg IV Correct Answer: B. While insulin and Kayexalate lower serum potassium, Calcium Gluconate acts immediately to stabilize the myocardial membrane and prevent fatal ventricular fibrillation. It is always the first-line emergency cardiprotective agent.