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Difficulty: MediumPharmacological Therapies

An older adult client diagnosed with heart failure is prescribed a daily scheduled dose of oral spironolactone. During the morning chart review, the practical nurse notes that the client's most recent serum potassium level is 5.8 mEq/L5.8 \text{ mEq/L}. Which action should the practical nurse take next?

  1. Withhold the spironolactone and promptly report the potassium level to the registered nurse.Answer
  2. B
    Document the elevated potassium level in the electronic health record and administer the scheduled dose.
  3. C
    Reduce the spironolactone to half the prescribed dose to compensate for the abnormal laboratory finding.
  4. D
    Proceed with administering the medication after verifying the client's room number and bed assignment.

Answer

Withhold the spironolactone and promptly report the potassium level to the registered nurse.
Spironolactone is a potassium-sparing diuretic that can cause or worsen hyperkalemia. A serum potassium level of 5.8 mEq/L5.8 \text{ mEq/L} is elevated above the normal expected range. Administering the medication under these conditions could lead to severe cardiac dysrhythmias. The practical nurse must withhold the medication and immediately notify the registered nurse or healthcare provider to ensure patient safety.

Step-by-Step Solution

1
Analyze the client's laboratory result.
The serum potassium level is 5.8 mEq/L5.8 \text{ mEq/L}, which indicates hyperkalemia (normal range is typically 3.53.5 to 5.0 mEq/L5.0 \text{ mEq/L}).
Recognizing abnormal laboratory values is essential before medication administration.
2
Identify the mechanism of the prescribed medication.
Spironolactone is a potassium-sparing diuretic.
Understanding the drug class helps predict how it will affect the client's current physiological state.
3
Determine the risk of administration.
Giving a potassium-sparing drug to a hyperkalemic client will dangerously increase potassium levels, risking fatal cardiac dysrhythmias.
Client safety is the primary priority when deciding whether to administer or withhold a drug.
4
Select the appropriate nursing intervention.
The practical nurse must withhold the dose and escalate the finding to the registered nurse.
This action remains within the practical nurse's scope of practice while preventing immediate harm to the client.

Key Concept

Pharmacological Therapies: Potassium-Sparing Diuretics and Critical Laboratory Monitoring
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Topics

Pharmacological Therapies

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