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
Potassium 3.8 mEq/L
The client reports dizziness upon standing.
The client reports difficulty hearing.
The Correct Answer is C
Choice A rationale:
A BUN level of 15 mg/dL is within a normal range.
Choice B rationale:
A potassium level of 3.8 mEq/L is within a normal range.
Choice C rationale:
Dizziness upon standing could indicate orthostatic hypotension, which could be a concern following administration of a diuretic like furosemide.
Choice D rationale:
Difficulty hearing is not typically associated with furosemide administration.
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Related Questions
Correct Answer is D
Explanation
A. Taking ferrous gluconate with 8 ounces of milk is incorrect. Calcium in milk can interfere with the absorption of iron, reducing its effectiveness. The client should be instructed to avoid taking iron supplements with dairy products.
B. It is not necessary to notify the provider if stools turn black. Black stools are a common and harmless side effect of iron supplementation due to the unabsorbed iron in the gastrointestinal tract. The client should be informed of this expected side effect.
C. Taking an antacid with ferrous gluconate is incorrect. Antacids can reduce the absorption of iron by altering the stomach's pH. If the client experiences stomach upset, the medication can be taken with food, although this may slightly reduce absorption.
D. Staying upright for at least 15 minutes after taking ferrous gluconate is correct. This practice helps prevent esophageal irritation, which can occur if the medication remains in contact with the esophageal lining. This statement indicates an understanding of the teaching.
Correct Answer is D
Explanation
Choice A rationale:
An INR of 1.6 is slightly elevated but does not necessarily warrant an incident report.
Choice B rationale:
A WBC count of 6,000/mm3 is within a normal range and would not warrant an incident report.
Choice C rationale:
A hemoglobin level of 16 g/dL is within a normal range and does not warrant an incident report.
Choice D rationale:
An aPTT of 90 seconds is significantly prolonged and may indicate excessive anticoagulation from the heparin administration. This could potentially be a safety concern and would warrant an incident report for further evaluation.
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