A nurse in an emergency department is reviewing the medical record of a client who is having an acute myocardial infarction.

Which of the following findings places the client at risk if he receives alteplase?

The correct answer is A.

Weight loss.

Furosemide is a loop diuretic that is used to treat fluid volume excess by increasing the excretion of water and electrolytes through the kidneys. Weight loss is an indication that the medication has been effective in reducing the excess fluid in the body.

Choice B is wrong because decreased inflammation is not a direct effect of furosemide.

Inflammation is a response to tissue injury or infection, and furosemide does not have any anti-inflammatory properties.

Choice C is wrong because increased blood pressure is not an indication of furosemide effectiveness.

Furosemide lowers blood pressure by reducing the preload and afterload on the heart.

Increased blood pressure may indicate that the dose of furosemide is insufficient or that there are other factors contributing to hypertension.

Choice D is wrong because decreased pain is not an expected outcome of furosemide therapy.

Furosemide does not have any analgesic effects, and pain may be caused by various conditions that are not related to fluid volume excess.

Normal ranges for weight, blood pressure and pain vary depending on the individual patient’s baseline and goals.

However, some general guidelines are:

• Weight: A weight loss of 0.5 to 1 kg per day is considered safe and effective for patients with fluid volume excess.
• Blood pressure: The target blood pressure for most patients with heart failure is less than 130/80 mmHg.
• Pain: The pain level should be assessed using a valid and reliable scale, such as the numeric rating scale or the visual analogue scale, and treated according to the patient’s preference and tolerance.

This instruction will help the client to prevent venous stasis and thrombosis, which are common postoperative complications. Range-of-motion exercises promote blood circulation and prevent muscle atrophy and contractures.

Choice B. “Use an incentive spirometer every 4 hours.” is wrong because it is not related to promoting circulation, but rather to improving lung expansion and preventing atelectasis and pneumonia. Using an incentive spirometer is also important for postoperative clients, but it does not address the question.

Choice C. “Remain on bed rest for 24 hours following the procedure.” is wrong because it is the opposite of promoting circulation.

Bed rest increases the risk of venous stasis, thrombosis, and pulmonary embolism. Postoperative clients should be encouraged to ambulate as soon as possible, unless contraindicated.

Choice D. “Place a pillow under your knees while in bed.” is wrong because it also impairs circulation and increases the risk of thrombosis.

Placing a pillow under the knees can cause pressure on the popliteal veins and reduce blood flow. Postoperative clients should avoid this position and keep their legs in a neutral or slightly elevated position.