A patient receiving intravenous potassium develops muscle weakness and the cardiac monitor shows widening QRS complexes. What should the nurse do first?
Correct answer: A. Stop the potassium infusion immediately
- A. Stop the potassium infusion immediately
- B. Encourage the patient to drink additional fluids
- C. Recheck the potassium level at the next routine time
- D. Ask the patient to walk to assess muscle strength
Explanation
Widened QRS complexes during potassium administration indicate potentially life-threatening potassium toxicity. The nurse stops the potassium source immediately and calls for urgent medical review while maintaining cardiac monitoring. Waiting for a routine blood test or encouraging activity delays treatment.
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About Clinical Judgement and Prioritisation
Clinical judgement links assessment findings, nursing knowledge and patient responses to a safe decision. Coverage includes ABCDE assessment, recognising actual or potential instability, prioritising airway, breathing and circulation, using urgency and risk rather than routine order, reassessing after intervention, and distinguishing a nursing priority from a medical diagnosis or a task that can wait.
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