A client who is admitted to the intensive care unit (ICU) with acute decompensated heart failure is receiving a continuous infusion of milrinone via a subclavian venous catheter. Which action should the nurse take when preparing to administer the first dose of IV furosemide?
Administer furosemide IV over ten minutes.
Notify the healthcare provider (HCP) of the incompatibility of the two drugs.
Infuse furosemide through a central line to prevent extravasation.
Give furosemide through a separate IV access
The Correct Answer is D
A. Administer furosemide IV over ten minutes. While slow IV administration is recommended to prevent ototoxicity, the priority concern is that milrinone and furosemide are incompatible when administered in the same IV line. The nurse must first ensure separate IV access before considering the administration rate.
B. Notify the healthcare provider (HCP) of the incompatibility of the two drugs. The nurse does not need to notify the HCP but should instead use a separate IV line or flush the line thoroughly before and after administration if only one access is available. Milrinone and furosemide should never be mixed, as their combination can cause precipitation, leading to catheter occlusion or embolization.
C. Infuse furosemide through a central line to prevent extravasation. Furosemide can be given peripherally or centrally, but the concern here is drug incompatibility, not extravasation. Furosemide is not a vesicant, so central line administration is not required unless no peripheral access is available.
D. Give furosemide through a separate IV access. Milrinone is incompatible with furosemide due to pH differences, which can lead to precipitation and potential catheter occlusion. To ensure safe administration, furosemide should be given through a separate IV line or, if no secondary access is available, the line should be flushed thoroughly before and after administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Administer a PRN dose of benzodiazepine.
Benzodiazepines can cause respiratory depression and prolong delirium, especially in clients recovering from mechanical ventilation and sedation. The client’s confusion is likely transient post-extubation delirium, which often resolves with reorientation and safety measures rather than sedation.
B. Increase the oxygen concentration to 60%.
The client is maintaining an oxygen saturation of 98% on 40% FiO₂, indicating adequate oxygenation. Increasing the oxygen concentration to 60% is unnecessary and may increase the risk of oxygen toxicity.
C. Apply bilateral wrist restraints.
The client is confused and attempting to get out of bed, increasing the risk of falls and accidental self-injury. Restraints should be used as a last resort after ensuring non-pharmacological interventions (e.g., reorientation, sitter, bed alarms) are ineffective or unavailable. If applied, restraints must be monitored closely and removed as soon as possible.
D. Notify the rapid response team.
The client’s vital signs are stable, and oxygenation is adequate. Although confusion is concerning, it does not indicate an immediate life-threatening emergency requiring a rapid response team. Instead, the nurse should implement safety interventions and continue close monitoring.
Correct Answer is ["C","E","F"]
Explanation
A. White blood cell differential. Although infection is a common precipitating factor for DKA, an elevated WBC count is common in DKA due to stress, dehydration, and inflammation rather than infection itself. While a WBC differential may be done if infection is suspected, it is not a primary test for DKA management.
B. Hemoglobin A1C. Hemoglobin A1C (HbA1c) reflects long-term glucose control (past 2-3 months) but does not provide immediate information about the current metabolic status or severity of DKA. While it may be useful in assessing overall diabetes management, it is not essential for acute DKA treatment.
C. Serum electrolytes. Patients with DKA experience significant electrolyte imbalances, particularly potassium depletion due to osmotic diuresis and insulin deficiency. Monitoring serum sodium, potassium, and bicarbonate is crucial for guiding fluid and electrolyte replacement therapy. Potassium levels may appear normal or high initially due to acidosis but typically drop with insulin administration.
D. Urine culture. A urine culture is only indicated if a urinary tract infection (UTI) is suspected as a trigger for DKA. However, routine urine culture is not required in every case of DKA unless there are symptoms of infection such as fever, dysuria, or pyuria.
E. Anion gap. DKA is a form of high anion gap metabolic acidosis, caused by the accumulation of ketones. The anion gap (AG) is calculated as (Na⁺ - [Cl⁻ + HCO₃⁻]), with a value >12 mEq/L indicating metabolic acidosis. Monitoring the anion gap helps assess the severity of acidosis and guide treatment progress, as a decreasing anion gap suggests resolution of ketosis.
F. Urine ketones. Urine ketone testing helps confirm the presence of ketoacidosis, particularly in the initial stages of DKA diagnosis. While serum beta-hydroxybutyrate is a more accurate indicator of ketone levels, urine ketones remain useful for initial screening and monitoring treatment response as they decrease with appropriate management.
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