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Difficulty: HardPharmacological Therapies

A practical nurse is reviewing the electronic health record of a client admitted with an exacerbation of chronic obstructive pulmonary disease and generalized edema. The provider has prescribed oral furosemide and oral levofloxacin. The morning chemistry panel reveals a serum potassium level of 2.8 mEq/L (normal: 3.5-5.0 mEq/L). During data collection, the practical nurse notes the client's blood pressure is 102/60 mm Hg and heart rate is 115 beats/min. The registered nurse is occupied with another admission and asks the practical nurse to administer all scheduled morning medications. Which action should the practical nurse take?

  1. A
    Administer the scheduled medications, then document the potassium level of 2.8 mEq/L in the electronic health record for the provider to review.
  2. B
    Administer the furosemide because the client's borderline blood pressure and tachycardia are expected findings with an acute exacerbation.
  3. Withhold the furosemide and immediately report the laboratory findings and vital signs to the registered nurse.Answer
  4. D
    Give the medications based on the registered nurse's instruction, bypassing the barcode scan since the registered nurse has already identified the client.

Answer

The practical nurse should withhold the furosemide and immediately report the laboratory findings and vital signs to the registered nurse.
Furosemide is a potassium-wasting loop diuretic. Administering it to a client with a critically low potassium level (2.8 mEq/L) can precipitate life-threatening cardiac dysrhythmias, which may already be developing given the client's tachycardia. The practical nurse's priority is client safety, requiring the medication to be withheld and the findings escalated to the registered nurse immediately.

Step-by-Step Solution

1
Analyze the morning laboratory results and vital signs.
The potassium level is 2.8 mEq/L, which is critically low. The client has borderline hypotension (102/60 mm Hg) and tachycardia (115 beats/min).
Data collection and identifying abnormal findings are essential practical nursing responsibilities before any medication administration.
2
Evaluate the pharmacological action of the prescribed medications against the client's data.
Furosemide is a loop diuretic that causes potassium excretion, which will worsen the client's severe hypokalemia.
Understanding medication actions and contraindications ensures client safety and prevents adverse events.
3
Determine the appropriate nursing intervention within the practical nurse's scope of practice.
The practical nurse must withhold the dangerous medication and immediately escalate the findings to the registered nurse.
The practical nurse is responsible for reporting critical data and withholding medications that pose an immediate risk to the client.

Key Concept

Recognizing critical laboratory values and medication contraindications to ensure safe administration.
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Topics

Pharmacological Therapies

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