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A nurse is caring for an older adult client who has heart failure and a prescription for a repeat dose of furosemide 40 mg orally.
Which of the following actions is the nurse's priority?

A.

Remind the client to change positions slowly.

B.

Prepare the client's medication.

C.

Record the client's urinary output.

D.

Review the client's electrolyte levels.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

While reminding the client to change positions slowly is important to prevent orthostatic hypotension, it is not the priority before administering furosemide.

Choice B rationale:

Preparing the client’s medication is an important step, but it should be done after reviewing the client’s electrolyte levels.

Choice C rationale:

Recording the client’s urinary output is important when administering furosemide, a diuretic, but it is not the priority action.

Choice D rationale:

Reviewing the client’s electrolyte levels is crucial before administering furosemide because it can cause electrolyte imbalances, including low potassium levels, which can lead to serious cardiac complications.


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Related Questions

Correct Answer is ["A","C","D","E"]

Explanation

Choice A rationale:

The gauge and length of needle used for an IM injection are important to document. This information can help track which supplies were used and can be useful for future reference.

Choice B rationale:

While it’s important to check the medication expiration date before administration, it’s not typically documented after administering medication.

Choice C rationale:

The dose of medication administered should always be documented. This helps ensure accurate medical records and allows healthcare providers to track how much of a medication a patient has received.

Choice D rationale:

The site of injection should be documented. This can help prevent complications such as repeated use of the same injection site.

Choice E rationale:

The time of administration should be documented. This helps keep track of when the patient received their medication, which is crucial for medications that need to be given at specific intervals.

Correct Answer is C

Explanation

Choice A rationale:

Rifampin does not typically cause insomnia.

Choice B rationale:

Rifampin can cause a red or orange discoloration of body fluids, including urine, not blue or green.

Choice C rationale:

It is recommended to take rifampin on an empty stomach, either 1 hour before or 2 hours after a meal.

Choice D rationale:

Unusual hair growth is not a known side effect of rifampin.

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