PGIMER Sangrur NO - 2023
Medical & Surgical Nursing
Easy
Which of the best interventions after rapid administration of KCl fluid?
Appeared in: PGIMER Sangrur NO - 2023
Explanation
- Rapid administration of KCl leads to acute hyperkalemia, a life-threatening electrolyte imbalance due to its cardiotoxic effects.
- The combination of intravenous regular insulin and dextrose is the first-line, most rapid intervention to manage severe hyperkalemia.
- Insulin works by activating the Na+/K+ pump, which shifts potassium from the bloodstream into the body's cells, thus lowering the serum potassium level.
- Dextrose (a form of glucose) is administered simultaneously to counteract insulin's effect of lowering blood sugar, thereby preventing iatrogenic hypoglycemia.
Why Other Options Were Wrong
- Option A: Ringer's Lactate (RL) solution contains potassium (4 mEq/L). Administering it to a patient who is already hyperkalemic would worsen the condition.
- Option B: Normal Saline (NS) does not actively lower serum potassium. It can help with volume expansion and promote renal excretion of potassium, but it is not a rapid or primary treatment for shifting potassium intracellularly.
- Option D: While sodium bicarbonate can help shift potassium into cells, its effect is slower than insulin and is most effective in patients who also have metabolic acidosis. It is not the universal first-line treatment for acute hyperkalemia.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Acute Hyperkalemia as background academic context rather than a clinical decision trigger.
- Nurses must recognize that rapid IV push or infusion of potassium is extremely dangerous and can be fatal. KCl must always be diluted and administered slowly via an infusion pump.
- The nurse's role in a hyperkalemic emergency includes stopping the potassium source, initiating continuous ECG monitoring, preparing emergency medications (calcium gluconate, insulin/dextrose), and frequently monitoring vital signs and blood glucose.
- What if? If the hyperkalemic patient's blood sugar was already high (e.g., greater than 250 mg/dL)? The provider might order insulin to be given without dextrose, but the nurse would still need to monitor blood glucose levels very closely as they will fall rapidly.
How to Approach the Question
- First, identify the core problem presented in the question. 'Rapid administration of KCl fluid' directly points to the complication of acute hyperkalemia.
- Next, recall the pathophysiology of hyperkalemia. High potassium in the blood is dangerous primarily because of its effects on the heart's electrical conduction.
- The question asks for the 'best' intervention, which implies the most effective and rapid treatment. Evaluate the options based on their mechanism of action for lowering potassium.
- Analyze Option A (RL): Contains K+, so it's contraindicated.
- Analyze Option B (NS): Dilutes K+ but doesn't actively shift it. Not a primary treatment.
- Analyze Option D (Sodium bicarbonate): Shifts K+ but is slower and best for acidosis.
Concept Tested & Keywords
- Concept Tested: Management of Acute Hyperkalemia
- Stem keywords: rapid administration, KCl fluid, interventions
- Lead-in keywords: best
- Clinical cues: Rapid administration of KCl is a classic cause of iatrogenic hyperkalemia, a medical emergency.
Question ID
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Reference Book
E6 Medicine Harrison 22e Part 1 p. 402-404
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 152-154
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 543-545
Practise the full PGIMER Sangrur NO - 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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