A client with heart failure has a stat dose of Lasix (Furosemide) ordered.

Ordered is Lasix 100 mg IV push now.

Available is Lasix (Furosemide) 40 mg for 4 mL. How many mL should the nurse give?.

Choice A rationale

Checking blood pressure is a routine vital sign assessment but does not directly address the immediate and life-threatening implications of severe hyperkalemia. While hypertension can be associated with renal disease, a potassium level of 6.8 mEq/L (normal range 3.5-5.0 mEq/L) requires urgent intervention to prevent cardiac dysrhythmias, which are a direct consequence of altered myocardial excitability.

Choice B rationale

Obtaining a serum sodium level is important for a comprehensive electrolyte assessment in ESRD, as hyponatremia or hypernatremia can also occur. However, sodium imbalances do not pose the same immediate, life-threatening cardiac risk as severe hyperkalemia. The priority is to address the critical potassium elevation to stabilize myocardial electrical activity.

Choice C rationale

Instructing the client to avoid high-potassium foods is a crucial long-term management strategy for hyperkalemia in ESRD. However, for an acute potassium level of 6.8 mEq/L, dietary modification alone will not rapidly lower the potassium to a safe range and address the immediate risk of cardiac arrest. Acute medical interventions are required.

Choice D rationale

Redrawing the potassium to verify results is the most appropriate initial action. A critically high potassium level, especially if unexpected or inconsistent with the client's current clinical status, warrants immediate confirmation. Laboratory errors can occur, and verifying the result ensures that subsequent potentially aggressive medical interventions are based on accurate data.

Choice A rationale

Bounding pulsations are typically associated with conditions causing increased stroke volume or hyperdynamic circulation, such as fluid overload or severe anemia. Premature ventricular contractions, however, disrupt the normal cardiac cycle by originating ectopically, leading to a less efficient ventricular contraction and often a diminished pulse volume rather than a bounding one.

Choice B rationale

Tachycardia, defined as a heart rate greater than 100 beats per minute, may occur with frequent PVCs if the compensatory pause following the PVC significantly shortens the overall cardiac cycle length. However, PVCs themselves often lead to a reduction in effective cardiac output for that beat, and the compensatory pause can lead to an overall irregular rhythm, not necessarily sustained tachycardia.

Choice C rationale

Bradycardia, a heart rate less than 60 beats per minute, is not a typical direct finding with isolated premature ventricular contractions. While very frequent PVCs might lead to a sensation of a slower rate if many beats are ineffective, the primary characteristic of PVCs is irregularity due to the premature beat and subsequent compensatory pause, rather than a consistently slow rhythm.

Choice D rationale

Premature ventricular contractions disrupt the normal sinus rhythm by introducing an early, aberrant beat followed by a compensatory pause. This physiological mechanism creates an uneven rhythm when auscultating the apical pulse, manifesting as an irregular beat. The ventricle contracts prematurely, leading to a less effective ejection and an observable irregularity in the heart rhythm.