During the morning shift, a practical nurse (PN) is reviewing the electronic health record for a client with pneumonia who recently developed peripheral edema. The new medication prescriptions include oral azithromycin and intravenous (IV) push bumetanide. The client's most recent basic metabolic panel reveals a serum potassium level of mEq/L ( mmol/L). Which is the most appropriate action for the PN to take?
- AAdminister the IV push bumetanide slowly over two minutes while closely monitoring the client's respiratory status and urine output.
- BAdminister the oral azithromycin as scheduled and document the potassium level in the chart for the provider's morning rounds.
- Withhold the medications, immediately report the critical potassium level to the registered nurse (RN), and clarify that the IV push medication requires RN administration.Answer
- DIdentify the client using their stated name and room number before administering the oral azithromycin, and defer the IV push medication to the RN.
Answer
Withhold the medications, immediately report the critical potassium level to the registered nurse (RN), and clarify that the IV push medication requires RN administration.
The client's serum potassium level of mEq/L is critically low. Bumetanide is a potassium-wasting loop diuretic that would dangerously exacerbate this hypokalemia. Additionally, administering medications via the intravenous (IV) push route is outside the standard scope of practice for a practical nurse (PN). Therefore, the safest and most appropriate action is to withhold the medications and immediately escalate both the critical laboratory value and the administration of the IV push medication to the registered nurse (RN).
Step-by-Step Solution
Key Concept
Medication safety involves recognizing critical laboratory values (such as hypokalemia), withholding contraindicated drugs (like loop diuretics), and adhering to the legal scope of practice regarding intravenous push administration.