A nurse is caring for a client who has acute heart failure and is receiving furosemide via IV bolus. The nurse should identify that which of the following findings indicates that the therapy has been effective?
Increased blood pressure
Decreased weight
Increased sodium level
Decreased blood glucose level
The Correct Answer is B
Furosemide is a potent loop diuretic that inhibits sodium and chloride reabsorption in the ascending limb of the loop of Henle. By promoting the excretion of water and electrolytes, it reduces circulatory overload and alleviates pulmonary congestion associated with acute decompensated heart failure.
Rationale:
A. Furosemide typically causes a decrease in blood pressure rather than an increase, as it reduces total circulating blood volume. While stabilizing heart failure may eventually improve cardiac output, the immediate effect of diuretic therapy is a reduction in preload and systemic pressure. An increase in blood pressure would not be a direct indicator of successful diuresis.
B. Decreased weight is the most reliable indicator of effective diuretic therapy because it reflects the loss of excess interstitial and intravascular fluid. In acute heart failure, rapid diuresis leads to the excretion of several liters of fluid, manifesting as a significant daily weight drop. The nurse monitors daily weights as a precise quantitative measure of the client's response to loop diuretics.
C. Loop diuretics like furosemide typically cause the excretion of sodium, which can lead to hyponatremia rather than an increase in sodium levels. Elevated sodium would suggest dehydration or inadequate water excretion, which is contrary to the goal of heart failure management. The nurse should monitor for electrolyte depletion as a side effect of the treatment's success.
D. Furosemide does not directly decrease blood glucose levels; in fact, loop diuretics can occasionally cause hyperglycemia or impaired glucose tolerance. A decrease in blood glucose is not a parameter used to evaluate the efficacy of fluid removal in heart failure. The nurse should focus on respiratory status, urine output, and weight changes to assess the medication's therapeutic impact.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Total parenteral nutritioncontains high concentrations of glucose, which stimulates the pancreas to secrete significant amounts of insulin. Abrupt cessation of this hypertonic solution can lead to a rapid drop in blood glucose levels, resulting in rebound hypoglycemia. Maintaining a consistent dextrose source is critical until the next TPN bag is prepared.
Rationale:
A.Dextrose 10% in water (D10W) is the appropriate fluid to administer because it provides enough glucose to prevent rebound hypoglycemia when TPN is unavailable. The patient's pancreas is primed to release high levels of insulin in response to the TPN; without a continued dextrose source, the patient's blood sugar will plummet. D10W serves as a temporary bridge to maintain glycemic stability.
B.0.9% sodium chloride is an isotonic solution that provides volume and electrolytes but contains no glucose. Administering this fluid alone would fail to prevent the severe hypoglycemia that occurs when the high-glucose TPN infusion is suddenly stopped. While it is useful for many clinical situations, it is inappropriate as a substitute for TPN in a patient requiring glucose maintenance.
C.0.45% sodium chloride is a hypotonic solution used for cellular dehydration and does not contain the calories or sugar necessary to counteract the patient's high insulin levels. Using this solution when TPN runs out would leave the patient vulnerable to symptomatic hypoglycemia and potential neurological complications. It is an inadequate substitute for the high dextrose concentration required by the patient's current metabolic state.
D.Lactated Ringer's is a balanced crystalloid solution used for fluid resuscitation and electrolyte replacement, but it contains negligible amounts of carbohydrate. It cannot maintain the blood glucose levels of a patient who has been receiving hypertonic TPN. The nurse must prioritize a dextrose-containing solution to avoid the life-threatening consequences of a sudden cessation of parenteral nutrition support.
Correct Answer is ["15"]
Explanation
Step 1 is to identify the ordered dose per kg, the client's weight in kg, and the available concentration
Ordered Dose: 30 mg/kg
Client weight: 20 kg
Available Concentration: 200 mg / 5 mL
Step 2 is to calculate the total dose in milligrams (mg) required for the child
Total mg dose = weight in kg × dosage (mg/kg)
Total mg dose = 20 × 30
20 × 30 = 600
Total mg dose = 600 mg
Step 3 is to calculate the volume to administer in milliliters (mL)
Volume = (Total mg dose ÷ Available dose) × Available volume
Volume = (600 ÷ 200) × 5
600 ÷ 200 = 3
3 × 5 = 15
Volume to administer = 15 mL
Step 4 is to round to the nearest whole number
15 = 15
Answer: 15 mL
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