A nurse is caring for a client who has pulmonary edema and a new prescription for furosemide 40 mg IV twice daily. Which of the following client findings indicates the prescription is appropriate?
Blood pressure 100/70 mm Hg
Vesicular breath sounds over the peripheral lung fields
Bilateral coarse, crackle breath sounds
Potassium 3.2 mEq/L (3.5 mEq/L to 5.0 mEq/L)
The Correct Answer is C
Choice A reason: Blood pressure of 100/70 mm Hg may suggest fluid overload, a component of pulmonary edema, but it’s not a specific indicator for furosemide use. This finding reflects systemic effects rather than direct lung involvement. Furosemide targets fluid in the alveoli, not just blood pressure changes. Without lung-specific signs like crackles, this alone doesn’t confirm the need for the diuretic, as hypotension could also indicate other issues unrelated to pulmonary edema’s primary pathology.
Choice B reason: Vesicular breath sounds are soft, normal sounds heard over healthy lung fields, indicating no fluid accumulation. Pulmonary edema, however, presents with abnormal sounds like crackles due to fluid in alveoli. Furosemide is prescribed to clear this fluid, so normal vesicular sounds suggest the lungs are clear, not requiring diuretic intervention. This finding contradicts the condition furosemide treats, making it an inappropriate indicator for the prescription in this context.
Choice C reason: Bilateral coarse crackles are hallmark signs of pulmonary edema, caused by fluid leaking into alveoli from increased left heart pressure. Furosemide, a loop diuretic, reduces this fluid by enhancing renal excretion, relieving lung congestion. This finding directly correlates with the drug’s purpose—removing excess fluid to improve oxygenation and reduce respiratory distress. Thus, crackles confirm the prescription’s appropriateness, targeting the core pathophysiology of pulmonary edema effectively.
Choice D reason: Potassium at 3.2 mEq/L is below normal (3.5-5.0 mEq/L), often a side effect of furosemide due to increased urinary potassium loss. However, this isn’t an indication for starting the drug; it’s a consequence to monitor post-administration. Pulmonary edema’s treatment focuses on fluid removal, not electrolyte levels initially. Low potassium might require correction, but it doesn’t justify the prescription, making this finding unrelated to furosemide’s therapeutic intent.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Choice A reason: Verifying TPN with another RN is a safety protocol for this high-risk, complex solution containing dextrose, amino acids, and lipids. Errors in formulation or additives can cause severe metabolic imbalances or infections. This double-check reduces risks, ensuring the prescribed nutrients match the bag’s contents. It’s a standard of care in TPN administration, protecting the client from potential harm due to preparation mistakes, especially given its central line delivery.
Choice B reason: TPN’s high dextrose content elevates blood glucose, risking hyperglycemia, especially in stressed or diabetic clients. Monitoring serum glucose during infusion allows timely insulin adjustments, preventing complications like osmotic diuresis or ketoacidosis. This action aligns with metabolic management, as TPN bypasses digestion, delivering glucose directly into the bloodstream. Regular checks ensure glycemic control, a critical aspect of safe parenteral nutrition therapy.
Choice C reason: Increasing the TPN infusion rate to catch up if delayed is dangerous, risking fluid overload, electrolyte shifts, and refeeding syndrome. TPN rates are calculated precisely based on caloric and fluid needs, administered via infusion pumps for consistency. Speeding it up disrupts this balance, potentially causing cardiac strain or metabolic chaos. This action violates administration guidelines, making it inappropriate and unsafe.
Choice D reason: Infusing 0.9% sodium chloride instead of TPN lacks calories, amino acids, and lipids, interrupting nutritional support and risking hypoglycemia from prior high-glucose TPN. Protocol recommends 10% dextrose if TPN is unavailable, maintaining some glucose input. Sodium chloride only provides hydration, not sustenance, undermining TPN’s purpose. This substitution fails to meet the client’s metabolic needs, rendering it an incorrect action.
Choice E reason: Daily weights assess fluid balance and nutritional efficacy in TPN clients, detecting overhydration (weight gain) or malnutrition (loss). TPN delivers precise fluid and calories, and weight changes signal adjustments needed in therapy. This non-invasive measure tracks trends, complementing lab data, and is a cornerstone of monitoring. It ensures the treatment meets goals without causing volume-related complications, making it essential.
Correct Answer is C
Explanation
Choice A reason: A parent with type 2 diabetes indicates a genetic risk for metabolic issues, possibly relevant to liver disease progression, like NAFLD. However, it’s historical data, not an immediate threat to transplant success. The priority lies with factors affecting post-operative care, like adherence, over family history. This statement, while useful, isn’t urgent for reporting now.
Choice B reason: Childhood asthma history suggests past respiratory issues, potentially complicating anesthesia or recovery, but if resolved, it’s low priority. End-stage liver disease focuses on hepatic function, not dormant lung conditions. Without current symptoms, this doesn’t impact transplant candidacy urgently, making it less critical than adherence concerns.
Choice C reason: Poor medication adherence is a red flag for transplant listing, as post-operative immunosuppressants prevent rejection, requiring strict compliance. Non-adherence risks graft failure, a life-threatening outcome in end-stage liver disease. This statement demands immediate provider attention to assess candidacy and plan interventions, prioritizing it over other concerns here.
Choice D reason: Lack of family support affects emotional coping and post-transplant care logistics, potentially stressing recovery, but it’s not an immediate medical risk. Adherence to medications directly impacts survival, outweighing psychosocial factors in urgency. This statement, while relevant, doesn’t necessitate urgent reporting compared to compliance issues.
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