# After receiving back-to-back albuterol nebulizers for status asthmaticus, a client now has HR 145, fine tremor, and serum K+ of 2.9 mEq/L. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

After receiving back-to-back albuterol nebulizers for status asthmaticus, a client now has HR 145, fine tremor, and serum K+ of 2.9 mEq/L. Which is the priority nursing action?

## Option

1. Switch to oral albuterol tablets to reduce side effects
2. Notify the provider, anticipate IV potassium replacement, and continue cardiac monitoring for arrhythmia **✔ Correct answer**
3. Administer additional albuterol to continue bronchodilation
4. Discontinue all asthma medications until potassium normalizes

**Correct answer: 2**

## Explanation

Correct (2): High-dose beta-2 agonists shift potassium intracellularly, causing hypokalemia with risk of arrhythmias (especially with concurrent diuretics or digoxin). Notify provider, anticipate IV potassium replacement, continuous ECG. Tachycardia and tremor are expected with high-dose beta-2 stimulation. (1) More albuterol worsens hypokalemia. (3) Oral tablets have systemic side effects without faster benefit. (4) Asthma control still required; just adjust dose.

## In-depth explanation

Memory Tip Beta-2 agonist overdose = "Tachy + Tremor + Low K." Beta-2 also causes mild HYPERglycemia (insulin and glucose shift). CPG Monitor K+ every 2-4h during continuous nebulizer therapy.

## Clinical scenario

Scenario 32-year-old male in status asthmaticus receiving back-to-back albuterol nebulizers × 3. Now HR 145, fine tremor, serum K+ 2.9 mEq/L, on continuous cardiac monitor.

## Key concepts

- **Beta-2 agonist hypokalemia** — Potassium shift into cells with intense beta-2 stimulation; common with high-dose albuterol.
- **Status asthmaticus** — Severe asthma exacerbation unresponsive to initial therapy; requires aggressive treatment.
- **Potassium replacement** — IV KCl indicated when K

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391771&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._