26. Which client has the greatest need for K+ replacement?
. A client in renal failure with a postdialysis serum K+ of 3.4.
. A client with a large NG output who is receiving Kayexalate with a serum K+ of 5.5.
. A client with cardiac disease who is about to receive furosemide with a K+ of 3.5.
. A client with cardiac disease who is about to receive spironolactone with a K+ of 3.5.
Test-Taking Tip
Focus on cardiac disease and the drug, if given, that will further affect the K+ level (i.e., cause loss of K+), so the client will need K+ replacement.
Content Area: Adult Health, Fluid and Electrolyte Imbalances; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
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Answer 1 is incorrect because generally clients with renal failure have trouble excreting potassium. In the days before the next dialysis treatment, the potassium will be increasing. It is not appropriate to give potassium to this client. Answer 2 is incorrect because this client's potassium is already too high. More potassium is not needed. Answer 3 is correct because clients with cardiac disease are vulnerable to arrhythmia when serum potassium is low. Furosemide will cause potassium loss. It is important to replace potassium before the furosemide is given. Answer 4 is incorrect because clients with cardiac disease are vulnerable to arrhythmia when serum potassium is low. Spironolactone is a potassium-sparing diuretic that would not be expected to drop the potassium level as much as furosemide would.