A client received a first dose of cyanocobalamin (Nascobal) 2 days ago. The nurse is monitoring the client's electrolytes because of the possibility of which clinical manifestation?
1. A marked decrease in serum osmolality and the risk of cerebral edema.
2. A marked decrease in calcium and the risk of tetany.
3. A marked decrease in potassium and the potential for dangerous dysrhythmias.
4. A decrease in sodium and the potential for renal failure.
Correct Answer: 3
Rationale 1: Cyanocobalamin does not decrease serum osmolality.
Rationale 2: Cyanocobalamin does not affect calcium levels.
Rationale 3: Cyanocobalamin can cause potassium levels to drop, which can lead to marked hypokalemia with the risk of lethal dysrhythmia.
Rationale 4: Cyanocobalamin can cause sodium retention with possible worsening of heart failure.
Global Rationale: Cyanocobalamin can cause potassium levels to drop, which can lead to marked hypokalemia with the risk of lethal dysrhythmia. Cyanocobalamin does not decrease serum osmolality or affect calcium levels. Cyanocobalamin can cause sodium retention with possible worsening of heart failure.
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