A nurse is caring for a client who has heart failure.
The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?

BUN 15 mg/dL.

The client reports difficulty hearing.

Potassium 3.8 mEq/L.

The client reports dizziness upon standing.

Answer and Explanation

The Correct Answer is B

Furosemide is a diuretic that is used to treat heart failure by reducing fluid retention and lowering blood pressure. It can cause some side effects, such as increased urination, thirst, dry mouth, headache, dizziness, nausea, and electrolyte imbalance.

Choice A is wrong because BUN (blood urea nitrogen) is a measure of kidney function and a normal range is 7 to 20 mg/dL.

A BUN of 15 mg/dL is not a cause for concern and does not indicate any adverse effect of furosemide.

Choice C is wrong because potassium is an electrolyte that is important for nerve and muscle function and a normal range is 3.5 to 5.0 mEq/L.

Potassium of 3.8 mEq/L is within the normal range and does not indicate any adverse effect of furosemide. However, furosemide can cause low potassium levels (hypokalemia) in some cases, so the nurse should monitor the client’s potassium levels regularly and advise the client to eat foods rich in potassium, such as bananas, oranges, and potatoes.

Choice D is wrong because dizziness upon standing is a common side effect of furosemide and does not require immediate notification of the provider. However, the nurse should instruct the client to rise slowly from a sitting or lying position to prevent falls and to drink enough fluids to prevent dehydration.

Choice B is correct because difficulty hearing or hearing loss is a rare but serious side effect of furosemide that may indicate ototoxicity (damage to the inner ear). This can be irreversible if not treated promptly and may affect the client’s quality of life and safety. The nurse should notify the provider immediately if the client reports difficulty hearing or any other signs of ototoxicity, such as ringing in the ears (tinnitus) or vertigo (a sensation of spinning). The provider may need to adjust the dose of furosemide or switch to another diuretic that is less ototoxic.

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Correct Answer is D

Explanation

This is because swelling of the feet can be a sign of lithium toxicity, which is a serious condition that can occur when the level of lithium in the blood is too high. Lithium toxicity can cause confusion, irregular heartbeat, muscle weakness, and kidney problems. Therefore, the client should report any signs of lithium toxicity to their provider as soon as possible.

Choice A is wrong because limiting foods containing tyramine is not necessary for clients taking lithium. Tyramine is a substance found in some foods that can interact with certain antidepressants called monoamine oxidase inhibitors (MAOIs), but not with lithium.

Choice B is wrong because decreasing the daily sodium intake can actually increase the risk of lithium toxicity.

Sodium helps to regulate the amount of lithium in the body, so if the sodium level is low, the lithium level can rise too high.

The client should maintain a normal sodium intake and drink enough fluids while taking lithium.

Choice C is wrong because taking this medication 2 hours before a meal is not required for clients taking lithium.

Lithium can be taken with or without food, but it should be taken at the same time each day to keep a steady level in the blood.

Taking lithium 2 hours before a meal may cause stomach upset, which is a common side effect of lithium.

A. Mix the medications with a semisolid food for the client. B. Administer more than one pill to the client at a time. C. Place the medications on the back of the client’s tongue. D. Tilt the client’s head back when administering the medications.

Correct Answer is A

Explanation

The nurse should plan to take the following action:

A) Mix the medications with a semisolid food for the client.

Mixing the medications with a semisolid food, such as applesauce or pudding, can make it easier for an older adult client with dysphagia to swallow the medications safely. It helps in reducing the risk of choking and aspiration. This approach is typically used for clients who have difficulty swallowing pills.

Options B, C, and D are not recommended for a client with dysphagia:

B) Administering more than one pill at a time can increase the risk of choking and aspiration, which should be avoided.

C) Placing medications on the back of the client's tongue can also lead to difficulty swallowing and an increased risk of aspiration.

D) Tilting the client's head back when administering medications is not recommended as it can lead to aspiration. The head should be kept in a neutral position to support safe swallowing.

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A nurse is caring for a client who has heart failure. The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?

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A nurse is caring for a client who has heart failure.
The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?