A nurse is caring for a client who has hyperkalemia and is receiving insulin therapy. Which of the following should the nurse recognize as an adverse outcome?

Choice A rationale A serum glucose of 58 mg/dL indicates hypoglycemia, which is a significant adverse outcome of insulin therapy. When insulin is administered to treat hyperkalemia, it works by shifting potassium into the cells along with glucose. This is why glucose is usually co-administered with insulin in these cases. If the insulin effect outweighs the glucose provided, the blood sugar drops below the normal range of 74 to 106 mg/dL. This can lead to central nervous system dysfunction, seizures, or coma if not corrected. Choice B rationale A serum sodium level of 138 mEq/L falls well within the normal physiological range of 136 to 145 mEq/L. Sodium is the primary extracellular cation responsible for maintaining osmotic pressure and fluid balance. Insulin therapy does not typically have a direct adverse effect on sodium levels. Since this value is normal, it does not represent an adverse outcome or a complication of the treatment being provided for hyperkalemia. The nurse would consider this a stable and expected laboratory finding. Choice C rationale A calcium level of 10.0 mg/dL is within the normal reference range of 9.0 to 10.5 mg/dL. Calcium is essential for myocardial contractility, nerve impulse transmission, and blood clotting. While intravenous calcium gluconate is often given in hyperkalemia to stabilize the cardiac membrane, the administration of insulin itself does not usually cause fluctuations in serum calcium levels. Therefore, a normal calcium result is not an adverse outcome, but rather an indication of electrolyte stability in the client. Choice D rationale A serum potassium of 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L. In a client being treated for hyperkalemia, which is defined as a potassium level greater than 5.0 mEq/L, this result indicates that the insulin therapy has been successful in lowering the potassium to a safe level. This is the desired therapeutic effect of the medication, not an adverse outcome. The nurse should continue to monitor the patient but can be reassured by this normalization.