NCLEX Question of the Day – Monday, April 13, 2026

Today’s question targets early recognition of medication-related complications and safe nursing action. That skill matters because nurses are often the first to notice when a treatment is helping, harming, or needs to be stopped. In real practice, catching a problem early can prevent a rapid decline.

Clinical Scenario

A 72-year-old client is admitted to a medical-surgical unit with worsening shortness of breath, bilateral crackles, and 3+ pitting edema in both lower legs. The client has a history of heart failure, chronic kidney disease stage 3, and hypertension. The provider prescribes furosemide 40 mg IV push. Two hours after receiving the dose, the nurse reviews the client’s status and notes urine output of 900 mL, blood pressure 98/60 mm Hg, heart rate 108/min, and new complaints of leg cramps and palpitations. Morning lab results now show potassium 2.9 mEq/L.

The Question

Which nursing action is the priority?

Answer Choices

1. A. Encourage the client to increase oral fluid intake to 3000 mL/day
2. B. Place the client on cardiac monitoring and notify the provider of the potassium level and symptoms
3. C. Reassure the client that muscle cramps are an expected effect of diuresis
4. D. Administer the next scheduled dose of furosemide to improve fluid removal

Correct Answer

B. Place the client on cardiac monitoring and notify the provider of the potassium level and symptoms

Detailed Rationale

This is a Pharmacology question focused on recognizing an adverse effect of a loop diuretic and responding safely. Furosemide works by increasing excretion of sodium, water, and potassium. That helps reduce fluid overload, which is why the client’s urine output increased. But the same drug can cause significant potassium loss.

The key finding here is potassium 2.9 mEq/L with leg cramps and palpitations. Those are not minor complaints. They suggest symptomatic hypokalemia, which can lead to dangerous cardiac dysrhythmias. In NCLEX-style priority questions, symptoms plus an abnormal lab value usually mean the nurse must act now, not just continue routine care.

The priority nursing actions are to assess and protect the client from the most immediate risk. In this case, that risk is an unstable heart rhythm. That is why cardiac monitoring comes first. The nurse should also notify the provider promptly because the client may need potassium replacement, a change in diuretic dosing, repeat labs, and closer hemodynamic monitoring.

The nurse should also do a focused assessment. That includes checking the current rhythm, asking about weakness, nausea, and chest discomfort, reassessing blood pressure and pulse, and reviewing renal function because kidney status affects how potassium is replaced. The nurse should monitor intake and output, repeat electrolyte results as ordered, and watch for worsening hypotension from continued diuresis.

This scenario also shows why nursing care is not just about the original problem. The client came in fluid overloaded, but now the more urgent issue is a treatment complication. Good nursing judgment means adjusting priorities as the patient’s condition changes.

On shift, the practical sequence would be: recognize the low potassium and symptoms, place the client on a monitor, assess rhythm and vital signs, hold further furosemide if appropriate per orders or facility policy until the provider is contacted, report the findings clearly, and prepare to administer potassium replacement as ordered. The nurse should continue to evaluate whether the benefits of diuresis are being outweighed by adverse effects such as electrolyte loss and hypotension.

Why the Other Options Are Wrong

A. Encourage the client to increase oral fluid intake to 3000 mL/day

This is unsafe. The client has heart failure and was admitted with fluid overload. Telling the client to drink large amounts of fluid could worsen pulmonary congestion and edema. It also does not fix the urgent problem, which is symptomatic hypokalemia.

C. Reassure the client that muscle cramps are an expected effect of diuresis

Muscle cramps may occur with electrolyte loss, but they should never be brushed off in this setting. The client also reports palpitations and has a potassium of 2.9 mEq/L. Reassurance alone delays treatment and ignores a potentially life-threatening complication.

D. Administer the next scheduled dose of furosemide to improve fluid removal

This would likely make the problem worse. Another dose of furosemide can lower potassium further and worsen hypotension. The client’s blood pressure is already borderline low, and the heart rate is elevated. Before giving more diuretic, the nurse must address the adverse effects already present.

Key Takeaways

• Loop diuretics like furosemide can cause potassium loss.
• Hypokalemia can show up as weakness, cramps, irregular pulse, palpitations, and ECG changes.
• When a low potassium level is paired with symptoms, think cardiac risk first.
• Treatment complications can become the new priority, even if the original diagnosis was fluid overload.

• What you’d do on shift:
• Review the latest electrolyte results before giving the next diuretic dose.
• Reassess vital signs, rhythm, symptoms, and urine output.
• Place the client on cardiac monitoring if hypokalemia is significant or symptomatic.
• Notify the provider promptly and prepare for potassium replacement.
• Continue monitoring for both fluid status and medication side effects.

Quick Practice Extension

1. A client receiving IV furosemide has a potassium level of 3.1 mEq/L but denies palpitations or weakness. What focused assessments should the nurse perform before the next dose?

2. A client with heart failure is taking digoxin and furosemide. Why does hypokalemia increase this client’s risk, and what findings would make the nurse act immediately?

NCLEX Question of the Day – Monday, April 13, 2026

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