# A client with acute kidney injury has a potassium level of 6.4 mEq/L and peaked T waves on the cardiac monitor. Which prescription should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397321&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with acute kidney injury has a potassium level of 6.4 mEq/L and peaked T waves on the cardiac monitor. Which prescription should the nurse implement first?

## Option

1. Encourage a high-potassium snack.
2. Administer a phosphate binder with meals.
3. Collect a routine urine specimen.
4. Administer IV calcium gluconate as prescribed. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Severe hyperkalemia with ECG changes threatens cardiac stability. IV calcium gluconate stabilizes the myocardium and is the priority when prescribed. Dietary potassium, routine specimens, and phosphate binders do not address the immediate dysrhythmia risk.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits Hyperkalemia with ECG changes.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For Hyperkalemia with ECG changes, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Hyperkalemia** — Elevated serum potassium that can cause life-threatening dysrhythmias.
- **Peaked T Waves** — An ECG change associated with hyperkalemia.
- **Calcium Gluconate** — A medication used to stabilize cardiac membranes during severe hyperkalemia.

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