Pediatric ATI Practice Exam

A nurse is caring for a preschooler with congestive heart failure, observing wide QRS complexes and peaked T waves. Which prescription should the nurse clarify?

1. Furosemide

2. Captopril

3. Regular insulin

4. Potassium chloride

The correct answer is: Potassium chloride

In the context of a preschooler with congestive heart failure presenting wide QRS complexes and peaked T waves, the identification of these specific changes on an electrocardiogram (ECG) suggests the potential presence of hyperkalemia, or elevated potassium levels in the blood. Peaked T waves are a classic sign of this electrolyte imbalance, which can occur in patients with congestive heart failure due to impaired renal function or medication effects. The prescription of potassium chloride should be clarified because it is a potassium supplement that can exacerbate hyperkalemia. Given the child's current signs of possible hyperkalemia, administering potassium chloride could lead to severe and potentially life-threatening cardiac complications. On the other hand, furosemide is a diuretic that helps remove excess fluid and potassium from the body, potentially benefiting the child’s condition. Captopril, an ACE inhibitor, can improve cardiac output and manage heart failure symptoms. Regular insulin, while primarily known for its role in diabetes management, can help lower potassium levels by driving potassium back into cells, particularly in cases of hyperkalemia. Therefore, the clarification of potassium chloride is crucial, as its administration would not only be inappropriate under these circumstances but could also worsen the child's health status.