A practical nurse is assigned to care for a client with a history of heart failure. The client is scheduled to receive oral furosemide and oral digoxin at this time. Upon reviewing the morning laboratory report, the nurse notes a serum potassium level of 2.9 mEq/L (2.9 mmol/L). The client's most recent apical pulse is 62 beats per minute. Based on these findings, which of the following is the most appropriate next action for the practical nurse?
- Withhold both the furosemide and the digoxin, and immediately notify the registered nurse.Answer
- BAdminister the digoxin because the apical pulse is greater than 60 beats per minute, but withhold the furosemide.
- CAdminister both medications as prescribed and encourage the client to consume a potassium-rich breakfast.
- DWithhold the medications and independently perform a comprehensive cardiovascular assessment before notifying the provider.
Answer
The most appropriate action is to withhold both the furosemide and the digoxin, and immediately notify the registered nurse.
A serum potassium level of 2.9 mEq/L (2.9 mmol/L) is critically low (the normal range is 3.5 to 5.0 mEq/L). Furosemide is a potassium-wasting loop diuretic that would further deplete the client's potassium levels. Additionally, hypokalemia significantly increases the client's risk for life-threatening digoxin toxicity, even when the apical pulse is within the standard administration parameter of being greater than 60 beats per minute. To reduce the potential for severe cardiovascular complications, the practical nurse must withhold both medications and immediately escalate these findings to the registered nurse.
Step-by-Step Solution
Key Concept
Reduction of risk potential regarding medication administration requires correlating critical laboratory values (such as hypokalemia) with high-risk medications (such as furosemide and digoxin) and escalating findings appropriately.