A patient is experiencing difficulty falling asleep and is prescribed a hypnotic medication.
Which of the following should the nurse assess before administration?

Choice A rationale

Furosemide is a potent loop diuretic that acts on the loop of Henle in the kidneys, inhibiting the reabsorption of sodium, chloride, and potassium. This action leads to a significant increase in the excretion of potassium, making hypokalemia a very common and expected side effect. The normal potassium range is 3.5 to 5.0 mEq/L, and values below this range can lead to serious cardiac arrhythmias, muscle weakness, and fatigue. Therefore, this medication is the most likely culprit.

Choice B rationale

Spironolactone is a potassium-sparing diuretic that acts as an aldosterone antagonist, promoting sodium and water excretion while retaining potassium. Instead of causing hypokalemia, it can lead to hyperkalemia, especially when used with other potassium-retaining drugs or in patients with impaired renal function. The normal potassium range is 3.5 to 5.0 mEq/L. Therefore, it would counteract, not contribute to, hypokalemia.

Choice C rationale

Lisinopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II, leading to decreased aldosterone secretion. Aldosterone promotes sodium and water retention and potassium excretion. By reducing aldosterone levels, lisinopril causes potassium retention, and therefore, its use is associated with a risk of hyperkalemia. Normal potassium range is 3.5 to 5.0 mEq/L. Thus, it would not be the cause of hypokalemia.

Choice D rationale

Metoprolol is a beta-blocker that primarily affects the heart rate and blood pressure by blocking beta-adrenergic receptors. It does not directly impact the renal excretion of potassium in the same manner as diuretics. While metabolic side effects can occur, they are generally not a primary cause of significant electrolyte imbalances like hypokalemia. Its main effect is on the cardiovascular system.

Choice A rationale

While following the medication schedule strictly is a crucial part of medication administration, it is not the absolute priority. Administering a medication at the wrong time could potentially harm the patient if other checks are not performed first, highlighting that the core safety checks are the foremost priority.

Choice B rationale

Ensuring the patient takes the medication correctly is an important step in the process, but it follows the initial and more critical steps of verifying the medication and dose. If the incorrect drug is prepared or the wrong dose is calculated, the act of the patient taking it correctly becomes irrelevant and potentially dangerous.

Choice C rationale

The nurse's highest priority is to confirm the right medication, dose, route, and patient, as this practice, known as the "five rights," is the cornerstone of patient safety. This step minimizes the risk of administering the wrong drug, the wrong dose, or to the wrong patient, which could lead to severe adverse outcomes.

Choice D rationale

Documentation is a vital part of the medication administration process for legal and continuity of care purposes, but it must be done after the medication has been administered. Documenting before the action is completed can lead to errors and is not considered a safe practice, therefore it cannot be the priority.