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?

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.

Choice A reason: Removing weights during repositioning disrupts skeletal traction’s constant pull, risking fracture misalignment or delayed healing. Traction maintains bone stability via weights and pulleys, essential for immobilization. Lifting the client without weights negates this, potentially shifting the fracture site. This action contradicts traction principles, compromising treatment efficacy and patient outcomes, making it unsafe and incorrect.

Choice B reason: Cleansing pin sites with hydrogen peroxide damages healthy tissue and delays healing by disrupting granulation, despite its antiseptic properties. Sterile saline or chlorhexidine is preferred, preserving skin integrity around traction pins. This outdated practice increases infection risk ironically, as tissue breakdown invites pathogens. It’s not aligned with current evidence-based care, rendering it inappropriate.

Choice C reason: Inspecting pin sites daily for redness, swelling, or pus detects infection early, a common traction complication like osteomyelitis. Chemotherapy or immobility heightens this risk, and prompt identification allows intervention, protecting bone health. This action aligns with standards, ensuring the fracture heals without secondary issues. It’s a proactive, essential step in traction management.

Choice D reason: Checking ropes every 8 hours ensures traction equipment integrity, preventing sudden weight drops that could misalign the fracture. While important, it’s secondary to infection monitoring, as fraying is less immediate than sepsis risk. Daily pin checks address a more urgent threat to healing. This action, though useful, isn’t the top priority here.