While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes

Question

The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? a. Contact the provider to request orders for an electrocardiogram and serum electro-lyte levels.
b. Evaluate the patient's urine output and request an order for intravenous potas-sium.
c. Hold the next dose of furosemide and re-quest an order for intravenous magnesium sulfate.
d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

Answer 1

A
This patient is taking a potassium-sparing diuretic and is ingesting dietary potassium in salt subs-titutes. The patient shows signs of hyperkalemia: confusion, shortness of breath, and tingling of the hands and feet. The cardiac effects can be fatal, especially if a patient also is taking digoxin. The most appropriate first action would be to obtain an ECG and serum electrolyte levels to evaluate the extent of the patient's hyperkalemia. The patient does not need increased potassium. Furosemide is a potassium-wasting diuretic and would be helpful. Magnesium sulfate is not in-dicated. Until the patient's status has been assessed further, intravenous insulin is not indicated.