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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?

BUN 15 mg/dL

Potassium 3.8 mEq/L

The client reports dizziness upon standing.

The client reports difficulty hearing.

Answer and Explanation

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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Correct Answer is B

Explanation

Choice A rationale:

Naloxone is an opioid antagonist and does not increase pain relief.

Choice B rationale:

Naloxone is used to reverse opioid overdose, and an increased respiratory rate is a therapeutic effect, as it helps to counteract the respiratory depression caused by opioids.

Choice C rationale:

Decreased blood pressure is not a therapeutic effect of naloxone.

Choice D rationale:

Naloxone is not used to treat nausea directly.

A. Give diphenhydramine IM. B. Administer epinephrine IM. C. Elevate the client's legs and feet. D. Replace the infusion with 0.9% sodium chloride.

Correct Answer is B

Explanation

Choice A rationale:

While diphenhydramine is used to manage allergic reactions, epinephrine is the first-line treatment for severe anaphylactic reactions.

Choice B rationale:

In cases of anaphylactic reactions, epinephrine is the first-line treatment to reverse the severe allergic response. It helps to relieve bronchoconstriction, improve blood pressure, and counteract the symptoms of anaphylaxis.

Choice C rationale:

Elevating the client's legs and feet is not the appropriate intervention for anaphylactic reactions.

Choice D rationale:

Replacing the infusion with 0.9% sodium chloride is not the priority action in managing anaphylactic reactions. Administering epinephrine and managing the client's airway and circulation are more important.

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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?

Nursing Test Bank

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