Place the prescribed actions in priority order for a client with severe hyperkalemia and ECG changes.
Ordered Response
Choose your responses, then check the answer.
Explanation
With severe hyperkalemia and ECG changes, monitor and escalate immediately, then give prescribed IV calcium to protect the heart. Intracellular-shift therapy lowers the circulating potassium temporarily, while removal therapy eliminates potassium from the body. Serial ECG, potassium, and glucose monitoring detect incomplete response, recurrence, and treatment-related hypoglycemia.
Correct sequence Monitor and escalate → protect the heart → shift potassium → remove potassium → reassess.
Why this is correct ECG toxicity makes this a time-critical emergency. IV calcium can improve electrical instability but does not lower the potassium concentration. Insulin with glucose moves potassium into cells temporarily, so a removal strategy and continued monitoring are still required. Repeating a clearly plausible result must not delay myocardial protection.
NCLEX decision rule Separate the treatment goals: calcium protects the myocardium, shift therapies buy time, removal therapies solve the potassium burden, and serial monitoring detects rebound and hypoglycemia.
References
1UK Kidney Association hyperkalemia guideline2023 clinical practice guideline
2Resuscitation Council UK 2025 special-circumstances guideline
Hyperkalemia emergencyA client with chronic kidney disease has potassium 6.8 mmol/L, peaked T waves, and QRS widening. The result fits the clinical context and IV access is present. Do not delay emergency treatment to repeat the laboratory test.
Myocardial Stabilization — Temporary reduction of cardiac membrane excitability from hyperkalemia without removing potassium from the body.
Intracellular Shift — Temporary movement of potassium from extracellular fluid into cells.
Peaked T Waves — An ECG finding associated with hyperkalemia.