A nurse is assessing a client prior to administering furosemide. For which of the following findings should the nurse withhold the medication and contact the provider?
Widened QRS complex on ECG
Blood pressure 168/74 mmHg
Inverted T waves on ECG
Urinary output of 30 mL in 3 hr
The Correct Answer is C
Furosemide is a potent loop diuretic that facilitates the excretion of water, sodium, and potassium by inhibiting the Na-K-2Cl symporter. Its use is frequently associated with profound electrolyte imbalances, particularly hypokalemia, which can lead to life-threatening cardiac arrhythmias and altered myocardial repolarization.
Rationale:
A. A widened QRS complex is usually associated with hyperkalemia or bundle branch blocks rather than the hypokalemia caused by furosemide. Since furosemide promotes potassium excretion, it would typically be used to help lower potassium levels in some clinical scenarios. While a widened QRS is a significant finding, it does not represent the specific electrolyte risk associated with the immediate administration of a loop diuretic.
B. A blood pressure of 168/74 mmHg indicates hypertension, which is often an indication for, rather than a contraindication to, the administration of furosemide. The diuretic will help reduce the circulating fluid volume, thereby lowering the systemic blood pressure. The nurse should administer the medication as prescribed to treat the elevated pressure, provided the patient is not displaying signs of acute dehydration or shock.
C. Inverted T waves on an electrocardiogram are a classic sign of hypokalemia, indicating that the patient's potassium levels are dangerously low. Because furosemide aggressively flushes potassium out of the body, giving it to a patient who is already hypokalemic could lead to fatal ventricular arrhythmias. The nurse must withhold the dose and contact the provider to address the electrolyte deficit before proceeding with diuresis.
D. A urinary output of 30 mL over 3 hr is low (10 mL/hr) and may suggest oliguria or renal insufficiency, but it is often the reason furosemide is being given. The drug is intended to stimulate the kidneys to increase urine production in patients with fluid overload. While the nurse should monitor renal function, low output alone is not as immediate a contraindication as the cardiac signs of severe electrolyte depletion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Diazepam is a long-acting benzodiazepinethat enhances the inhibitory effect of gamma-aminobutyric acid(GABA) within the central nervous system. It is utilized for procedural sedation to induce anxiolysis and amnesia. Its primary safety concern involves dose-dependent depression of the medullaryrespiratory centers.
Rationale:
A.Fever is not a recognized adverse effect of diazepam administration. Benzodiazepines typically do not interfere with the hypothalamic thermoregulatory center to cause an elevation in body temperature. If a client develops a fever during sedation, the nurse should investigate other causes such as an underlying infection or a reaction to a different pharmacological agent.
B.Respiratory depression is the most critical adverse effect to monitor during diazepam administration for moderate sedation. As a central nervous system depressant, diazepam can significantly decrease the respiratory rate and tidal volume, leading to hypoxia or apnea. The nurse must continuously monitor oxygen saturation and capnography to ensure the patient maintains adequate spontaneous ventilation and airway patency.
C.Hypertension is unlikely to occur with diazepam; rather, the drug often causes a slight decrease in blood pressure due to reduced anxiety and systemic vasodilation. Benzodiazepines do not stimulate the sympathetic nervous system. Monitoring for hypotension and bradycardia is more appropriate when assessing the hemodynamic stability of a client undergoing moderate sedation with this agent.
D.Hyperreflexia is an exaggerated reflex response that is inconsistent with the pharmacological profile of benzodiazepines. Diazepam acts as a muscle relaxant and anxiolytic, which typically results in diminished or normal reflexes. Hyperreflexia is more commonly associated with upper motor neuron lesions or certain drug withdrawal states rather than acute sedation with GABAergic medications.
Correct Answer is ["0.75"]
Explanation
Step 1 is to identify the ordered dose and the available dosage strength
Ordered Dose: 60 mg
Available Strength: 80 mg / 1 mL
Step 2 is to calculate the number of milliliters to administer
Volume to administer = (Ordered Dose ÷ Available Dose) × Available Volume
Volume to administer = (60 ÷ 80) × 1
60 ÷ 80 = 0.75
0.75 × 1 = 0.75
Volume to administer = 0.75 mL
Step 3 is to round to the nearest hundredth
0.75 = 0.75
Answer: 0.75 mL
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