A physician orders Lasix 40 mg IV twice daily. Morning labs show Na 148, BNP 900, K 2.0, BUN 10. Which nursing action is the priority?

A physician orders Lasix 40 mg IV twice daily. Morning labs show Na 148, BNP 900, K 2.0, BUN 10. Which nursing action is the priority?

• A. Administer the Lasix as ordered
• B. Notify the physician of the BNP level
• C. Assess the patient for edema
• D. Hold the dose and notify the physician about the potassium level

Answer: (D)

Key concept: safety when a diuretic is paired with a dangerous electrolyte imbalance. A loop diuretic like furosemide causes potassium to be lost in the urine. A potassium level of 2.0 mEq/L is severely low and puts the patient at high risk for life-threatening arrhythmias, especially in someone with heart failure (as indicated by the elevated BNP). Giving another dose would worsen the hypokalemia and markedly increase the risk to the patient. So the priority is to hold the next dose and notify the physician about the potassium level so potassium replacement can be ordered and the diuretic plan can be reassessed. While the elevated BNP and potential edema status are clinically relevant, they do not pose the immediate danger that severe hypokalemia does. Administering the diuretic as scheduled would not be safe until potassium is corrected or appropriately managed.

Key concept: safety when a diuretic is paired with a dangerous electrolyte imbalance. A loop diuretic like furosemide causes potassium to be lost in the urine. A potassium level of 2.0 mEq/L is severely low and puts the patient at high risk for life-threatening arrhythmias, especially in someone with heart failure (as indicated by the elevated BNP). Giving another dose would worsen the hypokalemia and markedly increase the risk to the patient.

So the priority is to hold the next dose and notify the physician about the potassium level so potassium replacement can be ordered and the diuretic plan can be reassessed. While the elevated BNP and potential edema status are clinically relevant, they do not pose the immediate danger that severe hypokalemia does. Administering the diuretic as scheduled would not be safe until potassium is corrected or appropriately managed.