A nurse is preparing to administer bumetanide to a client who has heart failure. Which of the following findings indicates effectiveness of the medication?

Bounding radial pulse

Alert and oriented to time, place, and person

Lung sounds clear on auscultation

Bowel sounds present in four quadrants on auscultation

Answer and Explanation

The Correct Answer is C

Rationale:

A. Bounding radial pulse: A bounding radial pulse is not an indication of the effectiveness of bumetanide. It may suggest fluid overload or increased blood pressure, which is contrary to the goal of diuretic therapy in heart failure.

B. Alert and oriented to time, place, and person: While this indicates the client is neurologically stable, it does not specifically reflect the effectiveness of bumetanide, which is focused on reducing fluid overload and improving lung and cardiac function.

C. Lung sounds clear on auscultation: Clear lung sounds indicate that fluid buildup in the lungs, which is common in heart failure, has improved. Bumetanide is a diuretic that reduces fluid overload, and clear lung sounds are a key sign that the medication is effectively treating the client's condition.

D. Bowel sounds present in four quadrants on auscultation: While normal bowel sounds are important, they are not directly related to the effectiveness of bumetanide. Bumetanide’s primary effect is on fluid balance and lung function, not gastrointestinal function.

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Correct Answer is ["A","D","E"]

Explanation

Rationale:

A. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L: A continuous IV insulin infusion is required in DKA to reduce blood glucose and correct ketosis rapidly. It is started after ensuring potassium levels are above 3.3 mEq/L to prevent hypokalemia.

B. Regular insulin 20 units subcutaneously: Subcutaneous insulin is slower acting and inappropriate for managing DKA, where rapid glucose control is needed. IV insulin provides immediate action, which is essential for treating DKA effectively.

C. Blood glucose checks every 4 hr: Blood glucose needs to be checked more frequently, every 1–2 hours, to adjust the insulin infusion rate. Every 4-hour checks are not sufficient for managing the fluctuating glucose levels in DKA.

D. Initiate cardiac monitoring: Cardiac monitoring is essential due to potential electrolyte imbalances, especially potassium, which can lead to arrhythmias. Elevated or fluctuating potassium levels in DKA increase the risk of serious heart disturbances.

E. 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr: Fluid resuscitation with isotonic saline addresses dehydration caused by hyperglycemia. The initial rate is higher to restore circulatory volume, and after the first hour, the rate is reduced to maintain hydration.

F. Insert indwelling urinary catheter: A urinary catheter is not needed unless there's a concern about urinary retention or precise output monitoring. The priority is fluid management, insulin therapy, and electrolyte monitoring in DKA.

G. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L: The client currently has hyperkalemia (5.5 mEq/L). Administering additional potassium chloride at this time would be contraindicated and could worsen the hyperkalemia, potentially leading to dangerous cardiac arrhythmias.

H. Dextrose 5% in water (DSW) intravenous at 5 ml/kg/hr for 4 hr: Dextrose is not given initially in DKA unless blood glucose is dangerously low. The primary focus is on lowering blood glucose with insulin and correcting ketosis.

A. Vasovagal bradycardia without syncope B. Sinus tachycardia with rates faster than 80/min C. Asymptomatic second-degree AV block D. Complete AV block with rates slower than 40/min

Correct Answer is D

Explanation

Rationale:

A. Vasovagal bradycardia without syncope: Vasovagal bradycardia, which is often caused by a reflex response to certain triggers, typically does not require a pacemaker. If the client is not experiencing syncope, a pacemaker is generally not indicated.

B. Sinus tachycardia with rates faster than 80/min: Sinus tachycardia is generally not an indication for a pacemaker. A heart rate faster than 80/min is often a physiological response to various conditions, such as exercise or stress, and usually does not require pacing unless.

C. Asymptomatic second-degree AV block: Asymptomatic second-degree AV block does not always require a pacemaker. Many individuals with this type of block do not experience significant symptoms, and treatment may not be necessary unless the block progresses.

D. Complete AV block with rates slower than 40/min: A complete AV block with a heart rate slower than 40/min is a serious condition that often requires the placement of a permanent pacemaker. This type of block disrupts the normal conduction between the atria and ventricles, leading to slow heart rates and inadequate cardiac output.

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A nurse is preparing to administer bumetanide to a client who has heart failure. Which of the following findings indicates effectiveness of the medication?

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