# A nurse is caring for a 68-year-old patient with diabetes mellitus type 2, chronic kidney disease stage 3, and heart failure with reduced ejection fraction. The patient reports feeling weak and nauseated, and recent laboratory results show elevated creatinine and potassium. Which nursing intervention should be prioritized?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543640  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is caring for a 68-year-old patient with diabetes mellitus type 2, chronic kidney disease stage 3, and heart failure with reduced ejection fraction. The patient reports feeling weak and nauseated, and recent laboratory results show elevated creatinine and potassium. Which nursing intervention should be prioritized?

## 보기

1. Administer prescribed insulin sliding scale for hyperglycemia
2. Hold the morning dose of lisinopril due to elevated creatinine
3. Immediately notify the healthcare provider about the laboratory results **✔ 정답**
4. Increase fluid restriction to 1000 mL per day

**정답: 3**

## 해설

The patient's symptoms and comorbidities indicate a complex, urgent situation requiring immediate provider notification for assessment. Other options address specific issues but do not prioritize the need for comprehensive evaluation.

## 심화 해설

Clinical Reasoning and Prioritization

This question tests your ability to prioritize nursing actions for a patient with a complex cardiovascular-kidney-metabolic (CKM) profile. The patient has type 2 diabetes, chronic kidney disease (CKD) stage 3, and heart failure with reduced ejection fraction (HFrEF), and is now presenting with weakness, nausea, and elevated creatinine and potassium. This is a classic clinical scenario of potential acute-on-chronic kidney injury with life-threatening hyperkalemia, a critical intersection point along the CKM continuum .

Analysis of the Correct Answer

The correct action is to immediately notify the healthcare provider about the laboratory results (Option 3). The patient’s reported symptoms of weakness and nausea are classic, albeit nonspecific, clinical manifestations of worsening uremia and hyperkalemia. The elevated creatinine signifies a further decline in the kidneys' already compromised filtration capacity, while an elevated potassium level in a patient with CKD stage 3 and HFrEF represents a direct and imminent threat of cardiac arrhythmias and cardiac arrest. Given the severity of this finding, the nurse’s priority is to communicate this critical change in status to the provider to obtain urgent medical orders for stabilizing the patient, such as intravenous calcium to protect the myocardium or shifting potassium intracellularly. This aligns with the modern approach to the CKM continuum, where prevention and management of decompensation in one organ system require immediate, coordinated action to prevent catastrophic failure in another, particularly the heart .

Analysis of Incorrect Answers

- Option 1: Administering insulin for hyperglycemia is a common intervention in diabetes management, but it is not the immediate priority. While insulin can help shift potassium into cells, this is a temporizing measure that requires a specific provider order for the indication of hyperkalemia, not hyperglycemia. The scenario does not provide a blood glucose level, making this intervention a guess and a lower priority than communicating the life-threatening lab values.

- Option 2: Holding the morning dose of lisinopril is a clinically sound consideration. As an angiotensin-converting enzyme (ACE) inhibitor, lisinopril is a cornerstone of therapy in HFrEF and CKD for its renoprotective and cardioprotective effects, but it can cause a rise in creatinine and potassium. However, the nurse’s independent decision to hold the medication without a provider order is outside the scope of practice. The priority is to report the findings so the provider can make the decision to adjust or temporarily discontinue the medication as part of a broader management plan within the CKM framework .

- Option 4: Increasing fluid restriction is a management strategy for volume overload in heart failure. However, in the setting of an acute rise in creatinine, the patient’s kidney function may be declining due to pre-renal causes like dehydration. Aggressively restricting fluids without a complete clinical picture, including blood pressure and volume status, could worsen the acute kidney injury. This intervention is not the immediate priority over addressing a potentially fatal electrolyte disturbance.

The foundational principle here is that across the cardiovascular-kidney-metabolic disease spectrum, acute metabolic disturbances like hyperkalemia represent a sentinel event requiring immediate, multidisciplinary communication to prevent progression to heart failure decompensation and mortality . The nurse’s role as the continuous bedside monitor is to recognize these critical lab-value changes and escalate them without delay.

## 임상 시나리오

Recognizing & Acting on Critical HyperkalemiaPrioritizing Life-Threatening Electrolyte Imbalances in CKM Patients
In patients with CKD and HFrEF, symptoms like weakness and nausea combined with elevated creatinine and potassium signal a potential acute-on-chronic kidney injury with life-threatening hyperkalemia. The nurse's immediate priority is to notify the provider of these critical lab values.

Hyperkalemia poses a direct and imminent risk of cardiac arrhythmias and cardiac arrest. The nurse must act as a safety net by promptly communicating this change in status to obtain urgent orders, such as IV calcium for cardioprotection or interventions to shift potassium intracellularly.

CautionDo not delay notification to independently implement interventions like holding medications or adjusting fluid restrictions. These actions require a provider's order and do not treat the immediate threat of a potassium level above 5.0 mEq/L.

## 핵심 개념

- **Hyperkalemia** — An abnormally high serum potassium level, often defined as >5.0 mEq/L, which can cause life-threatening cardiac arrhythmias.
- **Cardiovascular-Kidney-Metabolic (CKM) Continuum** — A framework describing the interconnected pathophysiology of cardiovascular disease, chronic kidney disease, and metabolic disorders like type 2 diabetes.
- **HFrEF** — Heart Failure with reduced Ejection Fraction, a type of heart failure where the left ventricle's pumping ability is impaired.
- **Uremia** — A clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities that develop in parallel with deterioration of kidney function.

## 같은 주제 문제

- [A nurse is caring for a 68-year-old patient with multiple comorbidities including diabetes…](https://mymerci.kr/pages/nclex_q.php?qn_id=543635)
- [A nurse is caring for a 72-year-old client with multiple comorbidities including hypertens…](https://mymerci.kr/pages/nclex_q.php?qn_id=543636)
- [A nurse is caring for a 68-year-old patient with multiple comorbidities including diabetes…](https://mymerci.kr/pages/nclex_q.php?qn_id=543637)
- [A 45-year-old patient with a history of asthma and obesity is admitted to the medical unit…](https://mymerci.kr/pages/nclex_q.php?qn_id=543638)
- [A 58-year-old patient with cirrhosis and chronic obstructive pulmonary disease is admitted…](https://mymerci.kr/pages/nclex_q.php?qn_id=543639)
- [A 55-year-old patient with hypertension, chronic obstructive pulmonary disease (COPD), and…](https://mymerci.kr/pages/nclex_q.php?qn_id=543641)
- [A 45-year-old patient with atrial fibrillation, chronic liver disease, and a history of fa…](https://mymerci.kr/pages/nclex_q.php?qn_id=543642)
- [A 75-year-old patient with diabetes mellitus, chronic kidney disease (CKD) stage 3, and he…](https://mymerci.kr/pages/nclex_q.php?qn_id=543643)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._