A nurse in the emergency department is caring for a client who accidentally doubled their last dose of diazepam.
After assessing the client, which of the following medications should the nurse plan to administer?

Choice A rationale

Magnesium levels within the normal range (1.3 to 2.1 mEq/L) are important for overall electrolyte balance, but sodium polystyrene sulfonate specifically targets potassium. While hyperkalemia can sometimes be associated with other electrolyte imbalances, a normal magnesium level does not directly indicate a therapeutic response to sodium polystyrene sulfonate, as its primary action is not on magnesium.

Choice B rationale

Calcium levels within the normal range (9 to 10.5 mg/dL) are essential for various physiological functions. Sodium polystyrene sulfonate primarily exchanges sodium ions for potassium ions, not calcium. Therefore, a normal calcium level does not reflect a therapeutic response to the medication, which is specifically aimed at reducing elevated potassium levels.

Choice C rationale

Sodium levels within the normal range (136 to 145 mEq/L) are crucial for fluid balance and neurological function. Sodium polystyrene sulfonate exchanges sodium for potassium, meaning it increases the body's sodium load. While a normal sodium level is desirable, it does not directly indicate the therapeutic efficacy of the medication in reducing potassium.

Choice D rationale

Potassium 4.8 mEq/L (3.5 to 5 mEq/L) indicates a therapeutic response. Sodium polystyrene sulfonate is an ion-exchange resin used to treat hyperkalemia by exchanging potassium ions for sodium ions in the gastrointestinal tract. A potassium level returning to within the normal range, from a previously elevated state, signifies that the medication has effectively lowered the excess potassium.

Choice A rationale

Furosemide, a loop diuretic, can cause ototoxicity, particularly with rapid IV administration or high doses. This adverse effect manifests as tinnitus, vertigo, or irreversible hearing loss due to its impact on the hair cells in the organ of Corti within the inner ear. Therefore, reporting any indications of hearing loss is crucial for client safety.

Choice B rationale

Taking the daily dose of furosemide at bedtime is generally not recommended. Furosemide has a rapid onset and relatively short duration of action, typically leading to increased urine production for several hours. Administering it at bedtime can disrupt sleep patterns due to frequent nocturia, making morning administration preferable to minimize nocturnal diuresis.

Choice C rationale

Daily weight monitoring is essential for clients taking furosemide for heart failure. Furosemide promotes diuresis, reducing fluid overload. Daily weight checks (normal variations are within 0.5-1 kg/day) allow for assessment of fluid balance and the effectiveness of the diuretic therapy, helping to identify both fluid excess and dehydration promptly.

Choice D rationale

Furosemide is a potassium-wasting diuretic, meaning it promotes the excretion of potassium from the body. Chronic use can lead to hypokalemia (normal range 3.5-5.0 mEq/L), which can cause muscle weakness, fatigue, and cardiac arrhythmias. Consuming foods high in potassium regularly helps mitigate this electrolyte imbalance and maintain physiological function.

Choice E rationale

Furosemide can cause orthostatic hypotension, a sudden drop in blood pressure upon standing. This occurs due to fluid volume depletion and vasodilation induced by the diuretic effect. Rising slowly from a sitting or lying position allows the cardiovascular system to compensate, reducing the risk of dizziness, syncope, and falls.