A nurse is planning care for a client with a serum potassium level of 6.0 mEq/L (normal range: 3.5–5.0 mEq/L). Which actions should the nurse anticipate? (Select all that apply)

Choice A reason: Initiating 0.33% sodium chloride infusion is not a standard treatment for hyperkalemia. It may be used for hydration but does not directly address elevated potassium levels. Hyperkalemia requires specific interventions like insulin, dextrose, or dialysis to lower potassium and prevent cardiac complications, making this action inappropriate. Choice B reason: Monitoring cardiac rhythm is critical in hyperkalemia, as elevated potassium disrupts cardiac membrane potential, risking arrhythmias like ventricular tachycardia or fibrillation. Continuous ECG monitoring detects changes like peaked T-waves or widened QRS complexes, allowing timely intervention to prevent life-threatening cardiac events in patients with high potassium levels. Choice C reason: Administering calcium gluconate stabilizes cardiac membranes in hyperkalemia by counteracting potassium’s depolarizing effects, reducing arrhythmia risk. It does not lower potassium but protects the heart until other treatments, like insulin or dialysis, reduce levels, making it a priority action in managing severe hyperkalemia. Choice D reason: Restricting potassium-rich foods prevents further elevation of serum potassium, which is critical in hyperkalemia to avoid exacerbating cardiac and neuromuscular risks. Dietary management complements other treatments like dialysis, ensuring long-term control of potassium levels in patients with impaired renal excretion.