NCLEX Question of the Day – Monday, May 11, 2026

Today’s NCLEX question targets early recognition of medication-related complications in a child. This matters because pediatric patients can decline fast, and subtle changes often appear before a full emergency develops. A safe nurse notices the pattern, connects it to the treatment being given, and acts before the child becomes unstable.

Clinical Scenario

A 6-year-old child is admitted to a pediatric unit with dehydration caused by 3 days of vomiting and diarrhea. The provider prescribes intravenous fluids with potassium chloride added after the child voids. The child now has an IV infusing at the prescribed rate. Four hours later, the nurse enters the room and finds the child quiet and less playful than earlier. The parent says, “He seems more tired now.”

The nurse reviews the latest findings:

• Heart rate: 64/min
• Respiratory rate: 22/min
• Blood pressure: 92/58 mm Hg
• Urine output: 0.4 mL/kg/hr for the last 2 hours
• Child reports “my legs feel weird”
• Telemetry shows peaked T waves

The child has no cardiac history. Before admission, the child had significant gastrointestinal fluid loss and poor oral intake.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Slow the IV infusion and recheck the child in 30 minutes
2. B. Stop the potassium-containing infusion and notify the provider immediately
3. C. Encourage the child to drink oral rehydration solution and continue monitoring
4. D. Administer a PRN antiemetic to improve tolerance of oral fluids

Correct Answer

B. Stop the potassium-containing infusion and notify the provider immediately

Detailed Rationale

This child is showing signs of possible hyperkalemia, and the nurse needs to act right away. The key clues are the peaked T waves, bradycardia for age, muscle weakness or abnormal sensations described as “legs feel weird,” and low urine output. When urine output drops, the body may not clear potassium well. If potassium continues to infuse, the serum level can rise further and trigger a dangerous dysrhythmia.

The first nursing action is to stop the source of potassium. This prevents the problem from worsening while the provider is contacted for urgent evaluation and treatment. In real practice, the nurse would also follow facility protocol, place the child on close cardiac monitoring if not already in place, reassess vital signs, verify IV patency, and prepare for stat laboratory testing such as serum potassium and renal function studies. Depending on the child’s condition and provider orders, treatment may include medications that stabilize the myocardium or shift potassium back into cells.

The reason this comes before comfort measures or delayed reassessment is simple: electrical instability of the heart is the immediate threat. A child who looks only “a little tired” can still be at high risk when ECG changes are present. Peaked T waves are not a minor finding. They are an early warning that potassium may already be affecting cardiac conduction.

The nurse should also think through why this happened. Potassium was added only after the child voided, which is correct practice. But the new low urine output suggests the child’s condition has changed since then. Safe nursing care is not just following the original order. It means reassessing whether the order is still safe based on the current status.

After stopping the infusion and notifying the provider, the nurse should continue focused assessment. This includes monitoring heart rhythm, pulse quality, level of consciousness, muscle strength, urine output, and repeat vital signs. The nurse should also check whether any other potassium sources are present, such as oral supplements or potassium-containing medications. Documentation should clearly note the assessment findings, the time the infusion was stopped, the provider notification, and the child’s response.

Why the Other Options Are Wrong

A. Slow the IV infusion and recheck the child in 30 minutes

This is unsafe because it delays treatment while potassium continues to enter the bloodstream. When signs point to hyperkalemia with ECG changes, the issue is not that the infusion is too fast. The issue is that potassium may no longer be safe at all. Waiting 30 minutes could allow the child to deteriorate.

C. Encourage the child to drink oral rehydration solution and continue monitoring

Oral rehydration may help some children with dehydration, but it does not address the immediate danger here. The child already has signs of a possible electrolyte emergency. Continuing to monitor without stopping potassium misses the highest-priority problem.

D. Administer a PRN antiemetic to improve tolerance of oral fluids

This focuses on the earlier cause of dehydration rather than the current threat. Even if nausea management is useful later, it does nothing to treat suspected hyperkalemia or protect the heart. Priority decisions on NCLEX often depend on what is most dangerous right now.

Key Takeaways

• Peaked T waves plus weakness or bradycardia should make the nurse think about hyperkalemia.
• Potassium should never continue infusing when new signs suggest the body cannot safely handle it.
• Low urine output matters because the kidneys are the main route for potassium excretion.
• The first step is to stop the potassium source, then notify the provider and monitor closely.
• Reassessment can change whether an earlier order is still safe.

• On-shift mini-checklist:
• Review urine output before and during potassium therapy.
• Watch for ECG changes, weakness, paresthesia, or an unexpectedly slow pulse.
• Stop potassium immediately if hyperkalemia is suspected.
• Notify the provider, get labs, and stay ready for emergency treatment.
• Document findings and the exact action taken.

Quick Practice Extension

1. A child receiving IV fluids without potassium becomes irritable, develops muscle cramps, and has a flattened T wave on ECG. Which electrolyte imbalance would you suspect first?

2. A pediatric client has a potassium replacement order but has not voided since arriving from the emergency department. What should the nurse clarify before starting the infusion?

Category today: Pediatrics

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