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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
A hematocrit (Hct) value of 44% is within the expected range and does not require immediate reporting.
Choice B rationale:
A white blood cell (WBC) count of 5,000/mm3 falls within the normal range and does not require immediate reporting.
Choice C rationale:
Elevated total bilirubin levels can indicate potential liver dysfunction, which can be a concern when a client is taking medications like amitriptyline. The nurse should report this value for further evaluation.
Choice D rationale:
A potassium level of 4.2 mEq/L is within the normal range and does not require immediate reporting.
Correct Answer is ["A","C","E"]
Explanation
Choice A rationale:
The nurse should teach the guardian to shake the device prior to administration to ensure that the medication is well mixed and delivered in the right dose.
Choice B rationale:
Soaking the inhaler in water is not a recommended action as this can damage the device and affect its function.
Choice C rationale:
The nurse should also teach the guardian to use a spacer with the inhaler, which is a device that attaches to the mouthpiece and helps deliver the medication more effectively to the lungs.
Choice D rationale:
The nurse should also not teach the guardian to have the child take one inhalation as needed for shortness of breath, as fluticasone is a long-acting corticosteroid that is used for maintenance therapy and prevention of asthma symptoms, not for acute relief. The child should have a separate rescue inhaler, such as albuterol, for quick relief of bronchospasm.
Choice E rationale
The nurse should instruct the guardian to rinse the child's mouth with water after using the inhaler to prevent oral candidiasis, which is a fungal infection that can occur from the steroid medication.
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