A patient with renal failure has a serum potassium level of 6.5 meq/l. The nurse knows that which drug is used to treat hyperkalemia in renal failure?

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

Sodium polystyrene sulfonate is a cation-exchange resin specifically designed to treat hyperkalemia.
Its primary mechanism is binding potassium ions in the large intestine and facilitating their removal from the body via the feces.
This method of removal is essential for patients with renal failure, as their kidneys cannot perform this function.
While its onset is slow, it is a definitive treatment for reducing the total body potassium load, unlike other temporary measures.

Option B: Insulin and Dextrose provide a temporary, rapid-acting solution by shifting potassium from the extracellular fluid into the cells. It does not remove potassium from the body.
Option C: Sodium Bicarbonate also shifts potassium into cells but is less effective than insulin and is primarily indicated when the patient has concurrent significant metabolic acidosis.
Option D: Calcium gluconate does not treat hyperkalemia itself; it does not lower the serum potassium level. Its sole purpose in this context is to counteract the cardiotoxic effects of high potassium.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of hyperkalemia in renal failure helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's primary role in managing hyperkalemia is continuous cardiac monitoring (ECG) to detect arrhythmias, frequent assessment of vital signs, and monitoring muscle strength.
It is crucial to understand the different onsets of action: Calcium gluconate is immediate for cardiac protection, Insulin is rapid for shifting potassium, and Kayexalate is slow for removing potassium.
Patient education should include dietary potassium restrictions (avoiding bananas, oranges, potatoes, spinach) for patients with chronic kidney disease.

How to Approach the Question

First, identify the critical clinical information provided: a patient with renal failure has a serum potassium of 6.5 mEq/L. This indicates severe hyperkalemia.
Next, understand the core of the question: it asks for a drug that 'treats' hyperkalemia. In the context of renal failure, a definitive treatment involves removing the excess potassium that the body cannot excrete.
Analyze each option's mechanism of action in the management of hyperkalemia.
Differentiate between the roles: Calcium gluconate protects the heart, Insulin/Dextrose and Bicarbonate temporarily shift potassium into cells, and Sodium polystyrene sulfonate actually removes potassium from the body.
Based on this differentiation, conclude that the drug which removes potassium is the most appropriate answer for 'treating' the underlying problem of potassium overload in a renal failure patient.

Concept Tested & Keywords

Concept Tested: Pharmacological management of hyperkalemia in renal failure.
Stem keywords: renal failure, serum potassium, 6.5 meq/l, hyperkalemia
Lead-in keywords: which drug is used to treat
Clinical cues: Serum potassium of 6.5 mEq/L indicates severe hyperkalemia, which is a medical emergency.
Clinical cues: The patient's diagnosis of renal failure is critical as it explains the body's inability to excrete potassium.

Q__obd4qyqK-8cSfPnTtOZ

E6 Medicine Harrison 22e Part 1 p. 402-404

E6 Medicine Davidson Principles Practice 24e p. 383-385

E6 Pharmacology Nursing Lilley 11e Part 2 p. 166-168

Practise the full AIIMS Rishikesh NO - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.