# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617426&lang=en > language: en > subject: Performance Improvement > category: MOC ## Question 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. Condition Select 1 Anaphylaxis to an IV medication Vasovagal reaction to the injection Sepsis-induced hypotension from pneumonia Hypovolemia from an unintended diuretic dose Actions to take Select 2 Notify the provider of the dose and vitals Give prescribed IM epinephrine per protocol Lay the client flat and stay at the bedside Chart that an incident report was completed Obtain blood cultures per the sepsis protocol Parameters to monitor Select 2 Serum lactate level Blood pressure and heart rate Hemoglobin and hematocrit Serum potassium Skin and lips for hives or swelling ## Explanation A 650 mL diuresis within 15 minutes, with blood pressure falling from 124/76 to 88/50 and heart rate rising from 82 to 112 in a client who takes no diuretics, indicates volume depletion from the furosemide given in error. The nurse lays the dizzy client flat, stays at the bedside, and notifies the provider of the exact dose and vital signs so fluid and electrolyte orders can follow; the event is reported through the safety system after the client is stable. Blood pressure with heart rate and serum potassium track volume status and the diuretic's electrolyte loss. ## In-depth explanation 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. References 1MedlinePlus — FurosemideFurosemide causes diuresis, dizziness, and electrolyte loss 2AHRQ PSNet — Root Cause AnalysisSystem review of errors after safety event reporting 32026 NCLEX-RN Test Plan (NCSBN)Error prevention and reporting within Management of Care ## Clinical scenario Scenario A client with pneumonia who takes no diuretics receives another client's furosemide 40 mg IV after a scanner failure and, 15 minutes later, is dizzy, hypotensive, and tachycardic after a 650 mL diuresis, with an unchanged temperature and respiratory rate. ## Key concepts - **Loop diuretic** — A diuretic such as furosemide that blocks sodium reabsorption in the loop of Henle and causes rapid water and potassium loss. - **Two patient identifiers** — Using two items, such as name and date of birth, to confirm identity before giving medication. - **Safety event report** — A confidential report to the facility's quality system that is separate from the medical record. ## Related questions - [A nurse manager is discussing patient safety culture with the unit team after a medication…](https://mymerci.kr/pages/nclex_q.php?qn_id=364797&lang=en) - [An RN realizes at 0900 that a pain assessment performed yesterday at 1700 was never docume…](https://mymerci.kr/pages/nclex_q.php?qn_id=372702&lang=en) - [An RN has just completed venipuncture for blood specimens on four assigned patients during…](https://mymerci.kr/pages/nclex_q.php?qn_id=372703&lang=en) - [Review the unit's Plan-Do-Study-Act timeline for reducing specimen-labeling errors and det…](https://mymerci.kr/pages/nclex_q.php?qn_id=394839&lang=en) - [A quality-improvement team is evaluating a central-line infection-prevention project. 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