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Zorluk: ZorPharmacological Therapies

A client admitted with an exacerbation of heart failure is scheduled to receive oral furosemide and oral metoprolol. Prior to administration, the practical nurse obtains the following data: blood pressure 88/54 mm Hg, heart rate 116 beats/min, respiratory rate 22 breaths/min, and a morning serum potassium level of 3.1 mEq/L (3.1 mmol/L). Which action is the most appropriate for the practical nurse to take?

  1. Withhold both medications and promptly report the vital signs and laboratory findings to the registered nurse.Cevap
  2. B
    Administer the metoprolol to manage the client's tachycardia, but withhold the furosemide due to the low potassium level.
  3. C
    Administer both medications as prescribed, ensuring the client remains on strict bed rest to prevent orthostatic hypotension.
  4. D
    Accept delegation from the registered nurse to administer the furosemide via intravenous push to rapidly improve the client's cardiac output.

Cevap

The most appropriate action is to withhold both the furosemide and the metoprolol, and immediately report the client's vital signs and potassium level to the registered nurse.
The client's hypotension (88/54 mm Hg) and compensatory tachycardia (116 beats/min) strongly suggest hypovolemia or decreased cardiac output. Metoprolol (a beta-blocker) will further decrease blood pressure, and furosemide (a loop diuretic) will exacerbate both the volume depletion and the existing hypokalemia (3.1 mEq/L). The safe and correct action is to withhold these medications and immediately escalate these critical findings to the registered nurse.

Adım Adım Çözüm

1
Analyze the client's vital signs.
The blood pressure of 88/54 mm Hg is hypotensive, and the heart rate of 116 beats/min is tachycardic, suggesting potential hypovolemia or inadequate cardiac output.
Vital signs must be evaluated against standard parameters prior to administering cardiac or antihypertensive medications.
2
Analyze the laboratory data.
The serum potassium level is 3.1 mEq/L, which indicates significant hypokalemia (normal is typically 3.5 to 5.0 mEq/L).
Diuretics actively alter electrolyte balances, making baseline lab checks mandatory.
3
Evaluate the mechanism and adverse effects of the scheduled medications.
Furosemide is a potassium-wasting loop diuretic that will worsen the hypokalemia and hypovolemia/hypotension. Metoprolol is a beta-blocker that will further lower the blood pressure.
Understanding pharmacodynamics prevents administering medications that could cause patient harm.
4
Determine the correct nursing intervention within the practical nurse scope of practice.
The practical nurse must withhold the contraindicated medications and escalate the critical findings to the registered nurse for immediate medical intervention.
Advocating for patient safety requires recognizing adverse trends and communicating effectively with the supervising nurse.

Anahtar Kavram

Pre-administration Medication Safety, Hemodynamic Instability, and Practical Nurse Scope of Practice
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Konular

Pharmacological Therapies

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