At 0900 on a medical-surgical unit, a nurse gives furosemide 40 mg IV push that was prescribed for another client with a similar surname. The wristband scanner was not working, and the nurse did not check a second identifier. The client who received the dose is being treated for community-acquired pneumonia and takes no diuretics. At 0800 the client's blood pressure was 124/76 mm Hg, heart rate 82/min, respiratory rate 18/min, and temperature 37.2°C (99.0°F). At 0915 the client reports dizziness when sitting up. Blood pressure is 88/50 mm Hg, heart rate 112/min, respiratory rate 18/min, and temperature 37.2°C (99.0°F); the client has voided 650 mL since 0900. The skin is warm and dry without rash, the lips and tongue are normal, and breath sounds are unchanged from 0800. The morning serum potassium was 3.6 mEq/L. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Quick answer
Hypovolemia from an unintended diuretic dose. Lay the client flat and stay at the bedside, and notify the provider of the dose and vital signs. Monitor blood pressure with heart rate, and serum potassium.

Why this is correct
IV furosemide acts within minutes and produces a large diuresis. This client's baseline at 0800 was 124/76 and 82/min; 15 minutes after the wrong-client dose the client has voided 650 mL and is hypotensive and tachycardic. Lying flat protects against a fall and supports venous return, and staying at the bedside allows repeat vital signs. The provider must know exactly what was given so fluid replacement and electrolyte checks can be ordered. Blood pressure and heart rate track volume status, and potassium is monitored because loop diuretics waste potassium and this client's baseline is already 3.6 mEq/L.

Easy analogy or mental picture
The client's tank was drained through a tap someone else was supposed to open: keep the client safe while the level is low, call for a refill, and check what drained out with the water (potassium).

Memory hook
Wrong-client drug: treat the drug's effect, tell the provider, and keep the incident report out of the chart.

NCLEX decision rule
After a medication error, act on the drug's expected effect first, notify the provider, and report through the facility system once the client is stable. Monitor the parameters that the drug's known action affects.

Why the other choices are wrong
Sepsis from the pneumonia can cause hypotension and tachycardia, but it would not appear within 15 minutes with a large diuresis while temperature and respiratory rate stay at baseline, so blood cultures and lactate target the wrong problem. A vasovagal reaction slows the heart rather than speeding it. Anaphylaxis would bring rash, lip or tongue swelling, or new wheeze, so IM epinephrine and a skin-and-lips check do not fit. Writing in the medical record that an incident report was filed is a commonly repeated but incorrect practice, because the report is a confidential quality document; the chart records the facts and the care given. Hemoglobin and hematocrit would track blood loss, which does not explain a 650 mL diuresis.