A nurse is assisting in the care of a male client who has a new prescription for furosemide.

Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide? Select the 3 findings the nurse should identify as a contraindication.

Potassium level

Client verbal report

Blood pressure

Prescription for digoxin

BUN

Answer and Explanation

Correct Answer : A,B,D

A. Potassium level: The potassium level of 3.2 mEq/L is below the normal range and indicates hypokalemia, which furosemide can worsen because it promotes potassium loss. Administering the medication now increases the risk of arrhythmias. Correcting the potassium imbalance is essential before giving a loop diuretic.

B. Client verbal report: The client reports diarrhea, dry mouth, and excessive thirst, which suggest ongoing fluid depletion. Giving furosemide in this state can lead to further intravascular volume loss and increase the risk of hypotension or renal impairment.

C. Blood pressure: The blood pressure of 122/68 mm Hg is stable and does not indicate hypotension or hemodynamic compromise. This value would not independently prevent the administration of furosemide, as diuretics can be safely given when blood pressure is within an acceptable range.

D. Prescription for digoxin: Furosemide-induced potassium loss raises the risk of digoxin toxicity, especially when the potassium level is already low. Hypokalemia sensitizes cardiac tissue to digoxin, increasing the chance of dangerous dysrhythmias. This combination requires correction of electrolytes before administering the diuretic.

E. BUN: The BUN of 19 mg/dL is within normal limits and does not indicate renal dysfunction or dehydration severe enough to contraindicate treatment. It provides no evidence of impaired renal clearance that would complicate furosemide use.

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Correct Answer is D

Explanation

A. Hypocalcemia: Heat exhaustion does not typically cause low calcium levels. Calcium imbalances are more often related to parathyroid disorders, vitamin D deficiency, or certain medications rather than fluid loss from heat exposure.

B. Hyperphosphatemia: Elevated phosphate levels are not characteristic of heat exhaustion. Phosphate disturbances usually occur with kidney dysfunction or severe cellular breakdown, not from dehydration and electrolyte loss due to heat.

C. Hyperkalemia: Potassium levels may actually decrease or remain normal in heat exhaustion due to excessive sweating and fluid loss. Hyperkalemia is not a primary concern unless there is underlying renal impairment or extensive tissue damage.

D. Hypernatremia: Excessive fluid loss through sweating without adequate water replacement leads to elevated sodium levels in the blood. Hypernatremia is a common electrolyte imbalance in heat exhaustion and contributes to symptoms such as thirst, confusion, and neurologic changes.

A. "A medication dose must be decreased if you develop tolerance." B. "Pain patches are applied each morning and removed at bedtime." C. "We will use intramuscular medications to control your pain." D. "Analgesia should be used around the clock to promote pain control."

Correct Answer is D

Explanation

A. "A medication dose must be decreased if you develop tolerance.": Tolerance means the body becomes accustomed to the medication, often requiring higher—not lower—doses to achieve relief. Reducing the dose would worsen pain and diminish comfort, which is inappropriate in terminal cancer pain management.

B. "Pain patches are applied each morning and removed at bedtime.": Transdermal pain patches, such as fentanyl, are designed to provide continuous analgesia over 48–72 hours. Removing them daily disrupts steady pain control and leads to breakthrough pain.

C. "We will use intramuscular medications to control your pain.": IM injections are painful, have unpredictable absorption, and are avoided for chronic or end-of-life pain management. More comfortable and reliable routes—oral, transdermal, or IV—are preferred to maintain consistent relief.

D. "Analgesia should be used around the clock to promote pain control.": Scheduled dosing maintains steady medication levels and prevents breakthrough pain, which is essential for terminal cancer clients. This approach supports comfort, reduces suffering, and aligns with best practices for palliative pain management.

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A nurse is assisting in the care of a male client who has a new prescription for furosemide. Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide? Select the 3 findings the nurse should identify as a contraindication.

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A nurse is assisting in the care of a male client who has a new prescription for furosemide.

Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide? Select the 3 findings the nurse should identify as a contraindication.