A dialysis-dependent adult has potassium 6.8 mmol/L, peaked T waves, and QRS widening. Match each prescribed intervention to its primary role in the emergency plan.
Matrix
Choose your responses, then check the answer.
Explanation
IV calcium protects the myocardium but does not lower serum potassium; ECG reassessment guides whether further calcium is needed. Insulin with glucose and nebulized beta2-agonist shift potassium into cells temporarily. Urgent hemodialysis removes potassium definitively in a dialysis-dependent client. A potassium binder can contribute to removal but has a slower onset and is an adjunct, not a substitute for immediate cardiac stabilization and temporizing therapy.
Correct Answer Rows 1 and 2 protect and monitor the myocardium, rows 3 and 4 shift potassium into cells, and rows 5 and 6 remove potassium from the body.
Why It Fits Severe hyperkalemia requires parallel treatment roles. Confusing a stabilizer with a potassium-lowering therapy leaves a critical gap.
Clinical Picture Calcium changes cardiac excitability, insulin-glucose and beta2 stimulation buy time, and dialysis removes the excess potassium. A binder acts more slowly.
Memory Link Protect, shift, remove: calcium protects; insulin and beta2 shift; dialysis removes.
NCLEX Rule With ECG toxicity, give cardiac protection promptly while arranging temporizing treatment and definitive potassium removal.
Why the Alternatives Fail Calcium alone does not remove potassium, and a binder alone is too slow for QRS widening. Dialysis does not replace the need for immediate myocardial protection while it is being arranged.
Sources
1UK Kidney Association Hyperkalaemia Guideline
22026 NCLEX-RN Test Plan
Emergency monitoring and escalation are active. Treatment must protect the myocardium, temporarily shift potassium into cells, and remove potassium from the body; these roles are complementary rather than interchangeable.
Hyperkalemia — An elevated serum potassium level that can impair cardiac conduction.
Peaked T Wave — An electrocardiographic change that can occur with elevated potassium.
Calcium Gluconate — A medication used to stabilize the myocardium during severe hyperkalemia.