# A client with chronic kidney disease is admitted with a serum potassium level of 7.2 mEq/L. The cardiac monitor shows peaked T waves and a widened QRS complex. Which prescription should the nurse implement first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505803&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A client with chronic kidney disease is admitted with a serum potassium level of 7.2 mEq/L. The cardiac monitor shows peaked T waves and a widened QRS complex. Which prescription should the nurse implement first?

## Option

1. Administer intravenous calcium gluconate **✔ Correct answer**
2. Administer intravenous regular insulin and 50% dextrose
3. Administer oral sodium polystyrene sulfonate
4. Prepare the client for emergency hemodialysis

**Correct answer: 1**

## Explanation

The client has severe hyperkalemia (7.2 mEq/L) with ECG changes (peaked T waves, widened QRS), indicating cardiac membrane instability. Intravenous calcium gluconate is the priority because it immediately stabilizes the cardiac membrane and prevents life-threatening arrhythmias. Insulin with dextrose shifts potassium intracellularly but does not provide immediate cardiac protection. Sodium polystyrene sulfonate removes potassium slowly via the GI tract and is not appropriate for acute ECG changes. Hemodialysis is definitive but takes time to arrange; calcium must be given first to protect the heart.

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