A dialysis-dependent adult has severe hyperkalemia with ECG changes. Complete the expected emergency treatment framework.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Severe hyperkalemia with QRS widening is an immediate dysrhythmia threat. Prescribed IV calcium is used first to stabilize the cardiac membrane; it does not lower serum potassium. Insulin with glucose shifts potassium into cells, so glucose must be monitored for delayed hypoglycemia and potassium must be rechecked for rebound. Definitive removal is still required, and urgent dialysis is appropriate for a dialysis-dependent client with severe hyperkalemia. Sodium bicarbonate is not a substitute for calcium when toxic ECG changes are present, and treatment should not be delayed while waiting for another laboratory draw when the clinical and ECG pattern is clear.
Correct Answer Protect the myocardium with prescribed IV calcium, shift potassium with insulin and glucose, monitor response, and arrange urgent potassium removal.
Why It Fits QRS widening signals cardiac toxicity; calcium acts rapidly on membrane stability while insulin and glucose temporarily reduce extracellular potassium.
Clinical Picture The client depends on dialysis, so temporizing therapies must be linked to definitive removal rather than treated as a complete solution.
Memory Link Calcium protects, insulin shifts, dialysis removes.
NCLEX Rule Separate therapies by purpose and reassess potassium, ECG, and glucose after emergency treatment.
Why the Alternatives Fail Oral teaching, dietary restriction alone, or delayed reassessment cannot address immediate electrical instability or remove the potassium burden.
Sources
1UK Kidney Association Acute Hyperkalaemia Guideline
2UK Kidney Association Hyperkalaemia in Hospital
3NCSBN 2026 NCLEX-RN Test Plan
Emergency departmentPotassium is 7.1 mmol/L. The client is weak and bradycardic, with tall peaked T waves and QRS widening. IV access and continuous cardiac monitoring are established. Emergency prescriptions are being entered while nephrology is contacted.
Hyperkalemia — An elevated serum potassium concentration that can impair neuromuscular and cardiac conduction.
Membrane stabilization — Temporary reduction of myocardial excitability with IV calcium without lowering serum potassium.
Intracellular shift — Temporary movement of potassium from extracellular fluid into cells, such as after insulin with glucose.