An hour after administering 60 mg of furosemide intravenously (IV), which assessments should the nurse perform to determine the patient’s response to treatment? (Select all that apply.)
Urinary output.
Skin elasticity.
Pain scale.
Lung sounds.
Oxygen saturation.
Correct Answer : A,D,E
Furosemide is a loop diuretic used to treat fluid retention and high blood pressure by increasing the amount of urine the body makes. Therefore, assessing urinary output is crucial to determine the patient’s response to treatment. Lung sounds and oxygen saturation should also be assessed as furosemide is often used to treat edema caused by heart failure. Improved lung sounds and oxygen saturation can indicate a reduction in fluid buildup in the lungs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While monitoring skin for breakdown is an important aspect of nursing care, especially for bedridden or immobile patients, it is not the most important intervention for a client admitted with possible anastomosis leakage.
Choice B rationale
An anastomotic leak is a serious complication that occurs when the surgical connection between two parts of the intestine leaks, allowing the contents of the gastrointestinal tract to leak into the abdominal cavity. This can lead to serious infection and sepsis. Strict intravenous
(IV) fluid replacement is crucial in this situation to prevent dehydration and maintain blood pressure.
Choice C rationale
Encouraging regular turning is an important aspect of nursing care to prevent pressure ulcers, especially for bedridden or immobile patients. However, it is not the most important intervention for a client admitted with possible anastomosis leakage.
Choice D rationale
Assessing wound drainage daily is an important aspect of postoperative care. However, in the case of a suspected anastomotic leak, more immediate and critical interventions are required.
Correct Answer is C
Explanation
Choice A rationale
While lean beef, salads, and baked potatoes can be part of a balanced diet, they do not specifically target the prevention of colon and rectal cancers. Red meat, in particular, has been associated with an increased risk of colorectal cancer.
Choice B rationale
Potatoes, low-fat breads, and applesauce can be part of a balanced diet, but they do not specifically target the prevention of colon and rectal cancers. A diet rich in whole grains, fruits, and vegetables is more beneficial.
Choice C rationale
A diet rich in oatmeal, raisins, and fruit with skin is high in fiber and antioxidants, which can help reduce the risk of colon and rectal cancers. This is especially important for clients with a strong family history of these cancers.
Choice D rationale
Chicken, rice, and wheat products can be part of a balanced diet, but they do not specifically target the prevention of colon and rectal cancers. A diet rich in whole grains, fruits, and vegetables is more beneficial.
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