Free Trial #8

Question

A client receiving nasogastric suctioning is experiencing diarrhea. The client is prescribed a morning dose of intravenous furosemide (Lasix) 20mg and the most recent serum potassium level is 3.0 mEq/L. What is the next nursing intervention?

Answers

  1. Withhold giving the furosemide notify the healthcare provider for further orders
    • Rationale:
  2. Administered the furosemide and notify the healthcare provider for further orders
    • Rationale:
  3. Turn off the nasogastric suctioning and administered a laxative
    • Rationale:
  4. No intervention is need because the potassium level is within normal range
    • Rationale:

Overview

Explanation

The correct answer is A. Furosemide (Lasix) is a diuretic that removes extra fluid from the body. With the removal of the extra fluid, the potassium level will decrease. The nurse needs to hold the morning dose and notify the prescribing healthcare provider immediately for further instructions. The other answer choices would not be correct or safe such as turning off the nasogastric suction, administering the medication, or providing no intervention as these actions would cause continued potassium loss. The potassium level should be between 3.5-5.5 mEq/L.

NCLEX TIP: Using critical thinking is recommended when reading priority questions. Recognizing key words in the answer choices will allow you to know how to choose the correct answer for the question. Go through each answer choice and decide if it is: Maslow’s hierarchy of needs, safety related, or following the nursing process (ADPIE). Never complete a nursing action that is outside the scope of practice.

Learning Outcomes

Test Taking Tip

Video Rationale