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Cardiac/Diuretics - Priority Sheet
Furosemide Nursing Considerations NCLEX Priority Sheet
Furosemide is a loop diuretic. NCLEX tests potassium loss, fluid volume status, blood pressure, renal function, ototoxicity, and the digoxin-hypokalemia trap.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Priority 1
What to do first
1. Check blood pressure, weight trend, edema, lung sounds, and urine output.
2. Review potassium and renal function before administration when ordered.
3. Assess for dehydration: thirst, weakness, dizziness, hypotension, tachycardia, or poor skin turgor.
Safety
Hold If
Notify the provider and follow protocol for severe hypotension, dehydration, very low potassium, worsening renal function, oliguria/anuria, severe dizziness, or hearing changes.
Do not independently replace potassium. Anticipate ordered electrolyte correction.
Monitoring
Labs to Watch
Watch K+, Na+, Mg++, BUN, creatinine, urine output, daily weight, and blood pressure.
Hypokalemia is the NCLEX headline because it increases dysrhythmia risk and can amplify digoxin toxicity.
Review Details
NCLEX Review Notes
Key Signs
Electrolyte loss: hypokalemia, hyponatremia, hypomagnesemia, metabolic alkalosis.
Volume depletion: hypotension, dizziness, weakness, thirst, tachycardia, poor urine output.
Ototoxicity: tinnitus or hearing change is high priority.
NCLEX Trap
Trap: a patient takes digoxin and furosemide; K+ is 3.1 mEq/L.
Safer answer: recognize increased digoxin toxicity risk, assess pulse and toxicity signs, notify the provider, and anticipate ordered potassium correction.
Related Pattern
Loop diuretic: furosemide wastes potassium.
Potassium-sparing contrast: spironolactone can increase potassium. NCLEX likes comparing hypoK+ vs hyperK+ risks.
Mini Quiz
Question: A patient receiving furosemide reports dizziness and has BP 86/50 with K+ 2.9. What is the priority?
Answer: hold per protocol, assess volume status and rhythm risk, notify the provider, and anticipate ordered electrolyte/volume management.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; DailyMed furosemide labeling; 2022 ACC/AHA/HFSA heart failure guideline.
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