# A client has a potassium level of 6.9 mEq/L and a widened QRS complex. For each finding or intervention, select the best classification. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395582&lang=en > language: en > subject: Illness Management > category: PA ## Question A client has a potassium level of 6.9 mEq/L and a widened QRS complex. For each finding or intervention, select the best classification. | | Immediate danger cue | Appropriate acute action | Unsafe or delays care | | --- | --- | --- | --- | | Potassium 6.9 mEq/L with a widened QRS complex | | | | | Begin continuous ECG monitoring and administer prescribed IV calcium | | | | | Administer prescribed insulin with glucose and perform scheduled glucose monitoring | | | | | Repeat serum potassium and ECG assessment and arrange potassium removal if elevation persists | | | | | Give an oral potassium supplement to correct weakness | | | | | Wait for an outpatient recheck despite the current ECG change | | | | ## Explanation Severe hyperkalemia with QRS widening threatens lethal dysrhythmia. Continuous ECG monitoring and prescribed IV calcium protect the myocardium; insulin with glucose shifts potassium intracellularly. Repeat potassium, ECG, and glucose checks identify response, hypoglycemia, or rebound while definitive potassium removal is arranged. ## In-depth explanation Quick answer QRS widening is an immediate danger cue. Give prescribed IV calcium for cardiac membrane stabilization, use insulin with glucose to shift potassium, monitor glucose, and reassess potassium and ECG while arranging potassium removal. Why this is correct Potassium 6.9 mEq/L with an ECG change is severe hyperkalemia with imminent dysrhythmia risk. Calcium protects the heart but does not lower serum potassium, so shifting and removal strategies are also required. Easy analogy or mental picture Calcium is a temporary shield around the heart; insulin moves potassium into cells, and removal therapy empties excess potassium from the body. Memory hook Protect the heart, shift the potassium, remove it, then recheck. NCLEX decision rule ECG changes move hyperkalemia into the emergency pathway. Monitor continuously, treat immediately as prescribed, and schedule repeat potassium and glucose testing because rebound hyperkalemia and treatment-related hypoglycemia can occur. Why the other choices are wrong Potassium supplementation directly worsens the problem. Waiting for an outpatient recheck ignores a current electrical instability and risks cardiac arrest. Source 1UK Kidney Association Hyperkalaemia Guideline 22026 NCLEX-RN Test Plan ## Clinical scenario The client is on continuous cardiac monitoring with IV access. The nurse implements the prescribed emergency hyperkalemia protocol and reassesses the ECG, potassium, glucose, and response to therapy. ## Key concepts - **Severe hyperkalemia** — A dangerously elevated serum potassium level that can disrupt cardiac conduction and cause fatal dysrhythmias. - **Cardiac membrane stabilization** — Temporary reduction of myocardial excitability with IV calcium while potassium-lowering treatment proceeds. - **Intracellular potassium shift** — Temporary movement of potassium from extracellular fluid into cells, such as with insulin and glucose. ## Related questions - [A client with suspected urosepsis has a temperature of 39.1 C, blood pressure 86/48 mm Hg,…](https://mymerci.kr/pages/nclex_q.php?qn_id=393666&lang=en) - [A client with diabetic ketoacidosis is prescribed IV insulin. 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Always follow current clinical guidelines and your institution’s protocols._