The nurse reviews follow-up findings for a client taking hydrochlorothiazide. Which finding requires prompt follow-up?
1Blood pressure 128/76 mm Hg without dizziness when standing
2Serum sodium 138 mEq/L with clear breath sounds
3A 0.5-kg weight decrease after reduced dependent edema
4Serum potassium 2.8 mEq/L with muscle cramps and palpitations✓ Correct answer
Explanation
Hydrochlorothiazide increases urinary potassium loss. Potassium 2.8 mEq/L with muscle cramps and palpitations indicates clinically significant hypokalemia and possible dysrhythmia risk, requiring prompt notification and treatment reassessment. The other findings reflect controlled blood pressure, normal sodium, or expected improvement in edema without an immediate safety signal.
Clinical reasoning Thiazide-induced potassium loss can impair skeletal-muscle function and cardiac repolarization. Symptoms plus a markedly low value increase urgency.
Decision rule Escalate symptomatic hypokalemia promptly and anticipate ECG assessment, medication review, and prescribed electrolyte replacement.
Thiazide-induced hypokalemia — Renal potassium loss caused by thiazide diuresis that can produce weakness, cramps, palpitations, or dysrhythmias.
Hydrochlorothiazide — A thiazide diuretic used for hypertension and edema that requires monitoring of electrolytes, volume status, and blood pressure.