What action should the nurse take first when a patient on furosemide reports muscle weakness?
Increase fluid intake.
Reduce the furosemide dosage.
Administer a potassium supplement.
Check serum potassium levels.
The Correct Answer is D
A. Increase fluid intake: Increasing oral hydration may improve overall fluid volume but does not specifically address the electrolyte imbalance caused by loop diuretics. Furosemide-induced muscle weakness is typically a manifestation of hypokalemia rather than simple dehydration. Encouraging fluids without assessing electrolyte status could potentially further dilute serum potassium levels through a shift.
B. Reduce the furosemide dosage: Modifying a prescribed medication dosage is outside the independent scope of nursing practice and requires a provider's order. While the diuretic may be the cause of the symptom, the nurse must first gather objective data to justify a change. The priority is to assess the severity of the biochemical abnormality.
C. Administer a potassium supplement: Providing a potassium supplement without a current laboratory value and a specific provider order is unsafe and potentially harmful. If the weakness is not due to hypokalemia, unnecessary supplementation could lead to life-threatening hyperkalemia and cardiac dysrhythmias. Data collection must precede pharmacological intervention in this clinical scenario.
D. Check serum potassium levels: Furosemide inhibits the Na-K-2Cl symporter in the thick ascending limb, leading to significant potassium wasting and potential hypokalemia. Muscle weakness is a classic clinical sign of low potassium, which affects the resting membrane potential of excitable tissues. Obtaining a serum level is the critical first step to confirm the diagnosis.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Administer diuretics:Diuretics are primarily used to treat fluid volume excess or hypertension by increasing renal excretion of water and sodium. They do not address the underlying cause of respiratory alkalosis, which is an excessive loss of carbon dioxide. They are inappropriate for managing primary acid-base disturbances of respiratory origin.
B. Initiate fluid restriction:Restricting fluid intake is a management strategy for conditions like SIADH or congestive heart failure. It has no impact on the partial pressure of arterial carbon dioxide or the alveolar ventilation rate. This intervention is unrelated to the physiological correction of alkalotic pH levels.
C. Encourage the patient to breathe into a paper bag:Respiratory alkalosis is caused by hyperventilation, which leads to hypocapnia and an elevated blood pH. Rebreathing exhaled air increases the inspiratory concentration of carbon dioxide, helping to restore normal PaCO2 and pH. This is a classic intervention for non-organic, anxiety-induced hyperventilation.
D. Provide supplemental oxygen therapy:Oxygen is indicated for hypoxemia but does not correct a high pH caused by low carbon dioxide levels. In some cases, providing high-flow oxygen can actually encourage further hyperventilation if not monitored correctly. The primary goal in alkalosis is carbon dioxide retention rather than oxygen supplementation.
Correct Answer is C
Explanation
A. pH 7.50, PCO2 35 mm Hg, HCO3 24 mEq/L:This result demonstrates an alkaline pH greater than 7.45, which defines alkalosis rather than acidosis. The PCO2is at the lower limit of normal, suggesting a respiratory cause for the alkalinity. It is the physiological opposite of the state seen in chronic obstructive pulmonary disease.
B. pH 7.40, PCO2 40 mm Hg, HCO3 24 mEq/L:These values represent a perfectly balanced acid-base status within normal reference ranges. The pH is neutral, and the carbon dioxide and bicarbonate levels indicate effective alveolar ventilation and renal compensation. There is no evidence of respiratory failure or acidotic stress.
C. pH 7.30, PCO2 50 mm Hg, HCO3 24 mEq/L:An arterial pH below 7.35 confirms acidosis, while a PCO2 above 45 mm Hg indicates alveolar hypoventilation. In COPD, the inability to expire carbon dioxide leads to its accumulation and the subsequent formation of carbonic acid. This specifically matches the criteria for acute respiratory acidosis.
D. pH 7.35, PCO2 40 mm Hg, HCO3 22 mEq/L:This pH is at the lower limit of normal, and the carbon dioxide level is within the expected range. The bicarbonate is slightly low, which would be more indicative of a metabolic process rather than respiratory retention. It does not reflect the hypercapnia typical of advanced COPD.
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