# A dialysis-dependent adult has severe hyperkalemia with ECG changes. Complete the expected emergency treatment framework.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546514&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A dialysis-dependent adult has severe hyperkalemia with ECG changes. Complete the expected emergency treatment framework.

Because ECG toxicity is present, anticipate prescribed ::선택::oral sodium restrictionsubcutaneous long-acting insulin aloneintravenous calciumroutine IV maintenance fluid to ::선택::stabilize the cardiac membraneremove potassium in the urinereplace total body potassiumtreat delayed hypoglycemia. Next use ::선택::vitamin K to reverse anticoagulationaspirin to inhibit plateletsiron to support erythropoiesisinsulin with glucose to shift potassium into cells while arranging ::선택::routine clinic follow-upurgent dialysisa high-potassium mealdischarge without repeat ECG or laboratory testing for definitive potassium removal.

## Explanation

Severe hyperkalemia with QRS widening is an immediate dysrhythmia threat. Prescribed IV calcium is used first to stabilize the cardiac membrane; it does not lower serum potassium. Insulin with glucose shifts potassium into cells, so glucose must be monitored for delayed hypoglycemia and potassium must be rechecked for rebound. Definitive removal is still required, and urgent dialysis is appropriate for a dialysis-dependent client with severe hyperkalemia. Sodium bicarbonate is not a substitute for calcium when toxic ECG changes are present, and treatment should not be delayed while waiting for another laboratory draw when the clinical and ECG pattern is clear.

## In-depth explanation

Correct Answer
Protect the myocardium with prescribed IV calcium, shift potassium with insulin and glucose, monitor response, and arrange urgent potassium removal.

Why It Fits
QRS widening signals cardiac toxicity; calcium acts rapidly on membrane stability while insulin and glucose temporarily reduce extracellular potassium.

Clinical Picture
The client depends on dialysis, so temporizing therapies must be linked to definitive removal rather than treated as a complete solution.

Memory Link
Calcium protects, insulin shifts, dialysis removes.

NCLEX Rule
Separate therapies by purpose and reassess potassium, ECG, and glucose after emergency treatment.

Why the Alternatives Fail
Oral teaching, dietary restriction alone, or delayed reassessment cannot address immediate electrical instability or remove the potassium burden.

Sources
1UK Kidney Association Acute Hyperkalaemia Guideline
2UK Kidney Association Hyperkalaemia in Hospital
3NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Emergency department
Potassium is 7.1 mmol/L. The client is weak and bradycardic, with tall peaked T waves and QRS widening. IV access and continuous cardiac monitoring are established. Emergency prescriptions are being entered while nephrology is contacted.

## Key concepts

- **Hyperkalemia** — An elevated serum potassium concentration that can impair neuromuscular and cardiac conduction.
- **Membrane stabilization** — Temporary reduction of myocardial excitability with IV calcium without lowering serum potassium.
- **Intracellular shift** — Temporary movement of potassium from extracellular fluid into cells, such as after insulin with glucose.

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