A patient has a potassium level of 2.8 mEq/L with ECG showing U waves. What is the priority intervention?

• A. Monitor ECG and vitals
• B. Notify provider and initiate potassium replacement per protocol
• C. Administer calcium gluconate
• D. Hold potassium

Answer: (B)

Low potassium with U waves on the ECG shows significant hypokalemia that can quickly lead to dangerous heart rhythms. The priority is to correct the potassium deficit promptly by starting potassium replacement per the unit protocol, and to notify the provider to obtain orders and ensure proper monitoring. This approach directly addresses the underlying problem and reduces the immediate risk to the heart.

Monitoring the ECG and vitals is important, but waiting to observe isn’t acceptable when a clear deficit with ECG changes is present. Calcium gluconate is used to stabilize the heart in hyperkalemia, not to treat hypokalemia. Holding potassium would worsen the deficiency and delay life-saving treatment.