A practical nurse is caring for a client receiving treatment for hypertension. The client'… — NCLEX-PN

A practical nurse is caring for a client receiving treatment for hypertension. The client's medication administration record includes scheduled oral doses of spironolactone $50\text{ mg}$ and amlodipine $5\text{ mg}$ . Upon reviewing the morning assessment data, the nurse notes a blood pressure of $128/82\text{ mmHg}$ , a serum sodium level of $138\text{ mEq/L}$ , and a serum potassium level of $5.9\text{ mEq/L}$ . Which action should the practical nurse take first?

Withhold the spironolactone and report the elevated potassium level to the registered nurse.Answer
B
Administer both medications as scheduled because the client's blood pressure demonstrates a therapeutic response.
C
Withhold the amlodipine and administer the spironolactone because the client's blood pressure is already within a normal range.
D
Contact the healthcare provider to independently request a prescription for a potassium-wasting loop diuretic.

Answer

The practical nurse should withhold the spironolactone and immediately report the critical potassium level to the registered nurse.

Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. A serum potassium level of

5.9\text{ mEq/L}

is significantly elevated (normal range is typically

3.5

5.0\text{ mEq/L}

) and places the client at risk for life-threatening cardiac dysrhythmias. The practical nurse must withhold the medication and immediately escalate this critical laboratory value to the registered nurse for further clinical judgment and provider notification.

Step-by-Step Solution

Review the client's morning laboratory results and vital signs.

The client has a critical serum potassium level of

5.9\text{ mEq/L}

(normal is

3.5

5.0\text{ mEq/L}

) and a stable blood pressure of

128/82\text{ mmHg}

To ensure physiological parameters are safe prior to medication administration.

Analyze the pharmacological effects of the prescribed medications.

Spironolactone is identified as a potassium-sparing diuretic, whereas amlodipine is a calcium channel blocker.

Administering a potassium-sparing diuretic will further increase the client's already dangerous potassium level.

Determine the appropriate nursing intervention within the practical nurse scope of practice.

The spironolactone must be withheld, and the supervising registered nurse must be notified immediately.

Practical nurses must recognize life-threatening critical labs and escalate them promptly without independently altering the medical plan.

Key Concept

Pharmacological principles of potassium-sparing diuretics and practical nurse scope of practice regarding critical laboratory values.

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