مريض فشل كلوي مزمن، البوتاسيوم عنده ٦٫٨ ملمول/لتر مع موجات T مدببة في التخطيط. أي دواء تتوقع الممرضة إعطاءه أولاً لحماية القلب؟

A client with chronic kidney disease has potassium 6.8 mmol/L with peaked T waves on the ECG. Which drug does the nurse expect to give first to protect the heart?

1. Oral sodium polystyrene sulfonate
2. IV rapid-acting insulin with glucose
3. High-dose IV furosemide
4. IV calcium gluconate

Answer: D) IV calcium gluconate. IV calcium stabilises the cardiac membrane within minutes and lowers arrhythmia risk, though it does not lower potassium. Insulin with glucose then shifts potassium into cells, followed by measures that remove it, such as binders, diuretics or dialysis.