NCLEX-PN® ExaminationPhysiological AdaptationMedium
A client with a history of chronic kidney disease (CKD) is admitted with a serum potassium level of 6.8 mEq/L. The nurse anticipates administering which medication as a priority to stabilize the cardiac membrane?
- AInsulin and dextrose
- BCalcium gluconate
- CFurosemide
- DSodium polystyrene sulfonate (Kayexalate)
Show answer & explanationAnswer & explanation
Correct answer: B. Calcium gluconate
In severe hyperkalemia, calcium gluconate is administered to stabilize the cardiac cell membrane and prevent life-threatening arrhythmias, acting quickly but not lowering potassium levels. Other treatments like insulin/dextrose, Kayexalate, and furosemide help shift or remove potassium from the body but do not offer immediate cardiac protection.
Why the other options are wrong
- A. Insulin and dextrose shift potassium into cells but do not directly stabilize the cardiac membrane.
- C. Furosemide promotes potassium excretion but does not offer immediate cardiac membrane stabilization.
- D. Sodium polystyrene sulfonate removes potassium from the body via the GI tract, but its onset of action is too slow for acute cardiac protection.
Hyperkalemia Cardiac Stabilization
Administering calcium gluconate is a critical intervention for severe hyperkalemia to protect the heart from life-threatening arrhythmias.
- Serum potassium >6.5 mEq/L is considered severe.
- Calcium gluconate does not lower potassium but protects the myocardium.
- Other treatments (insulin, albuterol, diuretics, Kayexalate) lower potassium after cardiac stabilization.
Memory trick: Calcium Calms Cardiac Chaos First!