Was my Professor wrong...

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Specializes in MICU.

The question goes somehow like this...

A patient comes to the ER and labs was drawn. The lab reports reveals sodium of 135 and potassium of 3.2. What would you do?

A) Give furosemide

B) Give spironactone

C) hold both medication

I chose C because if you give furosemide or spironolactone, it will deplete sodium level, since the sodium is already at the border line. My professor said give spironolactone due to low potassium level. I know potassium is really important but in clinical setting, I think I will hold both medication and call the doctor to change the furosemide to a drug that can increase sodium level as well.

I asked her about the sodium but she didn't give me a good rationale.

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Specializes in NICU, ICU, PICU, Academia.

Low potassium will mess you up a hundred times faster then low sodium. Low potassium will give you possibly lethal arrhythmias, sodium won't.

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Specializes in MICU.
Low potassium will mess you up a hundred times faster then low sodium. Low potassium will give you possibly lethal arrhythmias, sodium won't.

Why not hold both and call the doctor?

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Specializes in OR, Nursing Professional Development.
Why not hold both and call the doctor?

Because the sodium is still within in normal range (135-145). However, the potassium is low (3.5-5). What is the effect of spironolactone on potassium and what potassium related condition can it be used to treat? What is the effect of a low potassium level? Why would you be worried more about potassium than sodium?

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B.

Sodium level is normal, potassium is low. So give spironolactone and let the physician know about the potassium level.

If you know how spironolactone works, then you have your answer.

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Specializes in Neuro, Telemetry.

Spironolactone is not a major sodium waster. It does waste some sodium, but it effects the renal tubules much closer to the end of the line where most of the sodium going through has already been absorbed. While sodium is important, potassium is more important. Sodium is also easier to replace them potassium. This patient will likely get a potassium drip to bring up her levels as well as at the very least normal saline

You have to think of the bigger picture. This question does not state whether or not potassium and sodium supplementation is also ordered. Since the sodium is still WNL the diuretic is still ok to give. However, the potassium is low and the body needs some help holding onto it.

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Specializes in MICU.

Furosemide and spironolactone was ordered on the question. I already figured it out. Thanks

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Specializes in Reproductive & Public Health.

What's more important- addressing the hypokalemia or avoiding potential hyponatremia? What is the potential result of holding the drug until you can consult with the MD?

I am not an ER nurse and so know very little about these drugs, but I can liken it to something like methergine... If my patient is bleeding out and has a borderline BP, am I going to give the damn methergine or wait until I can get the doc on the phone lest I cause my patient to become transiently hypertensive? Which is more immediately life threatening? Of course in real life these decisions are usually not black and white like that (ie I would use a different uterotonic, bimanual compression etc) but in NCLEX-land it is an important exercise in prioritizing.

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Specializes in ICU, LTACH, Internal Medicine.

Well, your professors was wrong indeed. Because you were taught to treat NUMBERS, not the patient.

Why he is here in ER? If it is CHF, then Lasix probably will be needed, sodium or not. If it is liver cyrrhosis, BOTH will be needed. If it is a young woman with dysfunctional bleeding caused by ovarian polycystosis, Aldactone will be needed, potassium or not. And, if it is acute mania and lithium overdose, NEITHER will be needed.

The professor sure can speculate that, let's assume that the patient is already on the meds. But the main point remains: as a nurse (or any other health care provider, for that matter), you do nothing till you at least have a good educated guess of what is really going on.

P.S. I did probably about 5000 to 7000 questions while preparing to NCLEX, and not that many of them were so nonsensical. On original exam, all 75 I got were quite logical. Some of them were more detailed than reasonable, some were rather esotetic, some tested norms by the book numbers but none was in the realm of choosing between, essentially, two non-exact numbers.

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Well, your professors was wrong indeed. Because you were taught to treat NUMBERS, not the patient.

Why he is here in ER? If it is CHF, then Lasix probably will be needed, sodium or not. If it is liver cyrrhosis, BOTH will be needed. If it is a young woman with dysfunctional bleeding caused by ovarian polycystosis, Aldactone will be needed, potassium or not. And, if it is acute mania and lithium overdose, NEITHER will be needed.

The professor sure can speculate that, let's assume that the patient is already on the meds. But the main point remains: as a nurse (or any other health care provider, for that matter), you do nothing till you at least have a good educated guess of what is really going on.

P.S. I did probably about 5000 to 7000 questions while preparing to NCLEX, and not that many of them were so nonsensical. On original exam, all 75 I got were quite logical. Some of them were more detailed than reasonable, some were rather esotetic, some tested norms by the book numbers but none was in the realm of choosing between, essentially, two non-exact numbers.

Sodium is NOT the issue here. The patient has a low potassium level. Do you know how spironolactone works? If you give Lasix to this patient, what will happen to him? You are reading far too much into the question. Don't treat the numbers only. treat the patient.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Here is the issue and you should take this heart for all your future questions in school. In the world of nursing school, the questions only give you the ability to pick one answer and get out of the room. This means only the intervention that is stated in the answer will be done. No further things at all will be done after unless the answer specifies it. You cannot overthink the questions.

So in this question, if you pick c that means you held the medicine and no further actions were taken. There is no hold the medication and contact the doctor. It wasn't in the answer. So don't over think it.

Now if the patient needs to be diuresed, which answer would you pick based on the lab values. What do these lab values mean to the patient. What can possibly happen? How do these answers affect the patient?

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something to think about - the lethal injection for a death row inmate? it's high dose potassium. Stops the heart. Potassium is that important.

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