The prescriber orders furosemide 80 mg for a patient who has been retaining extra fluid after surgery. The nurse notes the following: BP of 142/88 (lying) and 108/60 (sitting); daily weight of 154 lb, a 1-lb drop from day before; serum potassium of 2.8 mEq/L.
What should the nurse do?
Administer medication.
Contact provider.
Hold medication
Give potassium supplement
The Correct Answer is B
The nurse should contact the provider before administering furosemide because the patient has a low serum potassium level of 2.8 mEq/L, which is below the normal range of 3.5 to 5.0 mEq/L. Furosemide is a diuretic that can cause potassium loss and worsen hypokalemia, which can lead to cardiac arrhythmias, muscle weakness, and fatigue. The nurse should also monitor the patient’s blood pressure, weight, and urine output, as furosemide can lower blood pressure and cause dehydration.
Choice A. Administer medication is wrong because the nurse should not give furosemide without checking with the provider first, as it could be harmful to the patient with low potassium.
Choice C. Hold medication is wrong because the nurse should not withhold furosemide without a valid reason or an order from the provider, as it could cause fluid overload and worsen the patient’s condition.
Choice D. Give potassium supplement is wrong because the nurse should not give potassium supplement without an order from the provider, as it could cause hyperkalemia or interact with other medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Terazosin is a medication that belongs to the class of alpha-adrenergic blockers, which relax the muscles in the prostate and bladder neck, making it easier to urinate.It also lowers blood pressure by relaxing the veins and arteries, allowing blood to flow more easily.Therefore, terazosin can cause dizziness or fainting, especially when getting up from a sitting or lying position.To prevent this, the patient should rise slowly and avoid standing for long periods or becoming overheated.
Choice B is wrong because terazosin is not a cure for benign prostatic hyperplasia (BPH), but a symptom reliever.Stopping the medication may cause the urinary problems to return or worsen.
The patient should continue taking terazosin as prescribed by the doctor, unless advised otherwise.
Choice C is wrong because decreasing fluid intake may increase the risk of dehydration, urinary tract infections, bladder stones, and kidney problems.
The patient should drink enough fluids to stay hydrated and flush out the urinary system.
Choice D is wrong because grapefruit juice may interact with terazosin and increase its blood levels, leading to more side effects such as low blood pressure, drowsiness, or headache.
The patient should avoid drinking grapefruit juice while taking terazosin, or consult the doctor before doing so.
Correct Answer is B
Explanation
This is because a PTT (partial thromboplastin time) test measures how long it takes for blood to clot. A normal PTT range is between 25 to 35 seconds. If the patient’s PTT is too long and greater than 80 seconds, it means their blood is taking too long to clot and they are at risk of bleeding excessively. The nurse should notify the doctor and expect an order to hold the dose of heparin, a type of anticoagulant that prevents blood clots by prolonging the PTT.
Choice A is wrong because continuing with the same dosage of heparin would not correct the prolonged PTT and could cause more bleeding problems for the patient.
Choice C is wrong because increasing the dosage of heparin would further prolong the PTT and increase the risk of bleeding.
Choice D is wrong because decreasing the dosage of heparin would not be enough to bring the PTT back to normal range and would still pose a bleeding risk for the patient.
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