An assigned client with peripheral edema and a history of heart failure is scheduled to receive a routine morning dose of oral torsemide. Review of the electronic health record reveals a morning serum potassium level of 2.7 mEq/L and a blood pressure of 108/64 mm Hg. What is the priority action for the practical nurse?
- ADispense the medication as prescribed and encourage the client to consume a breakfast rich in potassium.
- BDocument the findings in the chart and proceed with medication administration because the blood pressure is stable.
- Hold the diuretic medication and immediately communicate the laboratory results to the registered nurse.Answer
- DContact the pharmacy to independently request a prescription for an intravenous potassium supplement.
Answer
The practical nurse should withhold the torsemide and immediately notify the registered nurse about the critical potassium level.
Torsemide is a loop diuretic that promotes the excretion of water, sodium, and potassium. A serum potassium level of 2.7 mEq/L is critically low (the normal range is typically 3.5 to 5.0 mEq/L). Administering a potassium-wasting diuretic to a client who is already severely hypokalemic places them at immediate risk for life-threatening cardiac dysrhythmias. The practical nurse must safely withhold the dose and promptly escalate this critical laboratory finding to the registered nurse or provider to ensure patient safety.
Step-by-Step Solution
Key Concept
Safe medication administration and monitoring for adverse electrolyte effects of loop diuretics.