# A client with chronic kidney disease is waiting for dialysis. The serum potassium is 6.8 mEq/L, and the monitor now shows a widening QRS complex. Which prescribed action should the nurse carry out first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522677&lang=en  
> language: en  
> subject: Fluid/Electrolyte Imbalances  
> category: PA

## Question

A client with chronic kidney disease is waiting for dialysis. The serum potassium is 6.8 mEq/L, and the monitor now shows a widening QRS complex. Which prescribed action should the nurse carry out first?

## Option

1. Intravenous calcium gluconate to stabilize the cardiac cell membrane **✔ Correct answer**
2. Intravenous regular insulin with dextrose to move potassium into cells
3. Oral sodium zirconium cyclosilicate to clear potassium from the body
4. Intravenous sodium bicarbonate to treat the accompanying metabolic acidosis

**Correct answer: 1**

## Explanation

A widening QRS signals unstable cardiac conduction. Calcium protects the myocardium within minutes while the other prescribed therapies begin shifting or removing potassium.

## In-depth explanation

Quick answer
Give intravenous calcium first to protect the heart while potassium is lowered.

Why this is correct
Calcium does not lower the potassium level, and that is exactly why it comes first: it raises the threshold for a lethal rhythm during the minutes the shifting and removing agents need to work.

Easy analogy or mental picture
Calcium is the sandbag wall while the pumps drain the water. The picture explains sequence and does not suggest that calcium alone resolves the hyperkalemia.

Memory hook
Protect the heart, then shift, then remove.

NCLEX decision rule
With hyperkalemia plus ECG changes, give a membrane stabilizer first, then agents that shift potassium into cells, then agents or dialysis that remove it from the body.

Why the other choices are wrong
Insulin with dextrose, a potassium binder, and bicarbonate are all used in real hyperkalemia care, but each acts more slowly than the drug that protects conduction.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]KDIGO Clinical Practice GuidelinesKidney Disease: Improving Global Outcomes

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