A nurse is preparing to administer NPH insulin and regular insulin in the same syringe for a client. Which of the following actions should the nurse take?

Furosemide is a loop diureticthat inhibits the sodium-potassium-chloride symporter in the thick ascending limb of the loop of Henle. It effectively manages fluid overload by increasing renal excretion of water and electrolytes, though its efficacy can be significantly compromised by prostaglandin inhibition. Concurrent use of certain medications can impair renal blood flow and diminish the diuretic response.

Rationale:

A.Metoclopramide is a prokinetic agent used to enhance gastrointestinal motility and prevent nausea, and it does not have a known significant interaction with furosemide. While the nurse should monitor general fluid status, metoclopramide does not interfere with the renal mechanism of action of loop diuretics. It is considered a safe adjunct medication for patients requiring diuresis and gastric support.

B.Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, which is required for furosemide to effectively dilate renal vasculature and promote diuresis. Taking ibuprofen can lead to reduced renal perfusion and a blunted diuretic effect, potentially exacerbating fluid retention. The nurse must recognize this interaction as it can result in decreased therapeutic efficacy and increased risk of nephrotoxicity.

C.Citalopram is a selective serotonin reuptake inhibitor (SSRI) that does not directly interact with the pharmacological pathway of furosemide in the kidneys. While SSRIs can occasionally contribute to hyponatremia, they do not block the diuretic action or increase the risk of acute renal failure when combined with loop diuretics. No immediate clarification is required for this combination in a standard clinical setting.

D.Ondansetron is a serotonin 5-HT3 receptor antagonist used for the prevention of vomiting and does not pose a direct threat to the effectiveness of furosemide. It lacks the prostaglandin-inhibiting properties found in NSAIDs and does not alter renal hemodynamics. The nurse can safely administer ondansetron alongside furosemide as there is no significant competitive or antagonistic drug interaction between them.

Amphotericin B is a potent polyene antifungalagent utilized for systemic mycotic infections and endocarditis by binding to fungal ergosterolto create membrane pores. Due to its significant nephrotoxicityand risk of infusion-related reactions, specific administration protocols must be strictly followed to ensure patient safety.

Rationale:

A.Administering the medication over 2 hr is the standard protocol to minimize the risk of severe infusion-related reactions and cardiovascular instability. Rapid infusion of amphotericin B can lead to hypotension, bronchospasm, and arrhythmias. By extending the infusion time, the nurse allows for better systemic tolerance and reduces the acute inflammatory response associated with this medication.

B.Using a gravity flow set is incorrect because amphotericin B must be administered via an electronic infusion pump to ensure a precise and consistent rate. Gravity sets are prone to fluctuations that could inadvertently result in a rapid bolus, increasing the risk of cardiac arrest. Precise flow control is a mandatory nursing safety intervention for this high-alert medication.

C.Priming the tubing with 0.9% sodium chloride is contraindicated because amphotericin B is incompatible with saline and will precipitate into solid crystals. The IV line must be primed and flushed exclusively with 5% dextrose in water (D5W) before and after administration. Crystallization in the tubing can lead to emboli or catheter occlusion, posing a significant risk to the patient.

D.Discarding the medication if it is yellow is unnecessary because the amphotericin B lipid complex emulsion is naturally yellow or opaque in appearance. The nurse should only discard the medication if there is evidence of foreign particulate matter or distinct precipitation. Understanding the normal physical characteristics of the drug prevents the wasteful disposal of expensive and essential antifungal therapy.