The nurse notes that a prescribed medication includes potassium chloride elixir 40 mEq, po, did. Prior to administering the medication, the nurse checks the client's potassium level which is 6.5 mol/L. What is the best intervention by the nurse?
A. Administer the dose of potassium and document the serum potassium level in the chart.
B. Ask the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction.
C. Hold the dose of potassium and contact the doctor to report the serum potassium level.
D. Calculate the mL of the medication needed and record the amount on the fluid intake record.
The best intervention by the nurse in this scenario would be C. Hold the dose of potassium and contact the doctor to report the serum potassium level.
To arrive at this answer, let's analyze the information provided:
The nurse notes that the prescribed medication is potassium chloride elixir 40 mEq, po, did. This means that the doctor has ordered for the client to receive 40 milliequivalents of potassium chloride by mouth.
Prior to administering the medication, the nurse checks the client's potassium level, which is 6.5 mol/L. A potassium level of 6.5 mol/L is considered high, as the normal range for potassium is typically between 3.5 to 5.0 milliequivalents per liter (mEq/L). This elevated potassium level is known as hyperkalemia.
Given this information, it is important to consider the potential risks and complications associated with administering additional potassium to the client. Hyperkalemia can have serious consequences, including cardiac abnormalities and muscle weakness. Therefore, it would be appropriate for the nurse to hold the dose of potassium and contact the doctor to report the elevated potassium level. The nurse should seek guidance from the doctor to determine if any adjustments or alternative treatments are necessary to address the client's high potassium level.
Option A, administering the dose of potassium and documenting the serum potassium level in the chart, would not be appropriate because it involves giving more potassium when the client is already exhibiting hyperkalemia.
Option B, asking the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction, does not address the primary concern of the elevated potassium level. While fluid restriction may be a factor for consideration, it is not the primary priority in this case.
Option D, calculating the mL of the medication needed and recording the amount on the fluid intake record, is not appropriate because administering potassium to a client with hyperkalemia may worsen their condition.
Therefore, the best intervention by the nurse would be to hold the dose of potassium, contact the doctor to report the elevated potassium level, and seek further guidance regarding appropriate management of the client's hyperkalemia.