Nurse Erica plans to administer a Kayexalate enema to a client with a potassium level of 5.9 mEq/L. Correct administration and outcome would include the client:

• A. Retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.
• B. Retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea.
• C. Retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level.
• D. Retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

Answer: (A)

Kayexalate works by exchanging sodium for potassium in the colon, which binds potassium and promotes its excretion in stool. To allow this resin to contact the intestinal mucosa and perform the exchange, the enema must be held for a period of time—about 30 minutes is sufficient and commonly used. After administration, you typically see stool production with potassium being eliminated, so diarrhea is an expected outcome as part of the process.

The other ideas aren’t correct because there is no glucose exchange involved with Kayexalate, and while longer retention (up to 60 minutes) can be used, the essential point is that the resin exchanges sodium for potassium and that potassium is excreted in the stool, which often accompanies diarrhea.