A nurse is collecting data from a client who has heart failure prior to the administration of furosemide. For which of the following findings should the nurse withhold the medication?

Blood pressure of 80/40 mm/Hg

Oxygen saturation of 95%

Serum sodium level of 140 mEq/L

Serum potassium level of 4.8 mEq/L

Answer and Explanation

The Correct Answer is A

A. A blood pressure of 80/40 mm/Hg indicates hypotension, which is a contraindication for administering furosemide. The medication can further lower blood pressure and increase the risk of adverse effects.
B. An oxygen saturation of 95% is within normal limits and does not indicate a need to withhold furosemide.
C. A serum sodium level of 140 mEq/L is normal and would not warrant withholding the medication.
D. A serum potassium level of 4.8 mEq/L is also normal and safe for furosemide administration, as the medication may cause potassium loss but does not require withholding if the level is within range.

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Correct Answer is A

Explanation

A. A heart rate of 56/min indicates bradycardia, which can reduce cardiac output and lead to dizziness due to decreased cerebral perfusion.
B. A high temperature is not directly associated with bradycardia; fever typically causes tachycardia.
C. Hypoglycemia does not have a direct relationship with bradycardia; it is more commonly associated with symptoms like sweating, confusion, and tremors.
D. Cigarette smoking typically contributes to conditions like tachycardia and vascular constriction, not bradycardia.

A. I’ll wear low-heeled shoes from now on. B. I’ll carry heavy objects close to my body. C. I’ll sit with my knees lower than my hips. D. I’ll do exercises that strengthen my abdominal muscles.

Correct Answer is C

Explanation

A. Wearing low-heeled shoes is advisable to promote better posture and alignment, so this statement is appropriate.
B. Carrying heavy objects close to the body is a recommended practice for preventing back injury, indicating correct understanding.
C. Sitting with knees lower than hips can lead to poor posture and increased strain on the lower back, indicating a need for further clarification. The correct position should have the knees level or slightly higher than the hips.
D. Strengthening abdominal muscles is beneficial for back support and injury prevention, indicating the client understands the concept.

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A nurse is collecting data from a client who has heart failure prior to the administration of furosemide. For which of the following findings should the nurse withhold the medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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