A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, the nurse should include which of these outcomes related to the therapeutic effects of the medication?

Choice A reason: Furosemide, a loop diuretic, promotes potassium excretion, risking hypokalemia. The patient’s potassium level (3.1 mEq/L) is below normal (3.5-5.0 mEq/L), indicating hypokalemia, which can cause arrhythmias. Administering Lasix without addressing this could worsen the electrolyte imbalance, making this choice unsafe and incorrect.

Choice B reason: Oxygen administration addresses respiratory issues, not electrolyte imbalances like hypokalemia (3.1 mEq/L) caused by furosemide. There’s no indication of hypoxia in the lab results or scenario. This action doesn’t correct the potassium deficit or prevent further depletion, making it irrelevant and incorrect.

Choice C reason: Furosemide exacerbates hypokalemia (patient’s potassium: 3.1 mEq/L), risking cardiac arrhythmias or muscle weakness. Holding the dose prevents further potassium loss, and notifying the physician allows for correction (e.g., potassium supplements) and reassessment of therapy, making this the safest and most appropriate action.

Choice D reason: A 24-hour urine collection assesses renal function or output but doesn’t address the immediate concern of hypokalemia (3.1 mEq/L) caused by furosemide. This test is irrelevant to correcting the electrolyte imbalance or preventing further depletion, making it an inappropriate action in this scenario.

Choice A reason: Metoprolol (beta-blocker) and furosemide (loop diuretic) are commonly used in heart failure. Furosemide may lower potassium, counteracting hyperkalemia (5.5 mEq/L), and metoprolol doesn’t significantly affect potassium. This combination poses less risk for hyperkalemia exacerbation, making it less concerning than potassium-sparing combinations.

Choice B reason: Furosemide promotes potassium excretion, potentially reducing hyperkalemia (5.5 mEq/L), while enalapril (ACE inhibitor) may increase potassium. However, furosemide’s effect often offsets enalapril’s, making this combination less likely to worsen hyperkalemia significantly compared to two potassium-sparing drugs, so this choice is less critical.

Choice C reason: Captopril (ACE inhibitor) and spironolactone (potassium-sparing diuretic) both increase potassium levels by reducing aldosterone activity, exacerbating hyperkalemia (5.5 mEq/L). In heart failure, this combination risks severe hyperkalemia, causing arrhythmias, making it the most concerning interaction requiring close monitoring or adjustment.

Choice D reason: Amlodipine (calcium channel blocker) and propranolol (beta-blocker) primarily affect blood pressure and heart rate, not potassium levels. Their interaction may cause bradycardia or hypotension but doesn’t worsen hyperkalemia (5.5 mEq/L), making this combination less concerning for the patient’s current electrolyte status.