A 70-year-old male receiving high-dose IV furosemide for heart failure complains of ringing in his ears and dizziness. His current labs show normal potassium and sodium levels. What is the nurse's most appropriate intervention?
Increase the infusion rate and check the patient's sodium levels again in 2 hours
Administer potassium supplements and continue the infusion
Reassure the patient that the symptoms are temporary and continue monitoring
Stop the furosemide infusion and notify the provider
The Correct Answer is D
A. Increasing the infusion rate may exacerbate the patient's symptoms and does not address the potential toxicity from the furosemide.
B. Normal potassium levels indicate that potassium supplementation is unnecessary and does not address the dizziness and ringing in the ears, which could suggest ototoxicity from furosemide.
C. While reassurance can help, the patient's symptoms indicate a potential adverse reaction to the medication that should not be ignored.
D. Stopping the furosemide infusion and notifying the provider is the most appropriate action due to the risk of ototoxicity and the need for further evaluation of the patient's symptoms.
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Correct Answer is A
Explanation
A. Respiratory acidosis is indicated by the low pH (7.22) and elevated PaCO2 (68 mm Hg), demonstrating that CO2 is retained due to hypoventilation (as seen with a respiratory rate of 7/min). The bicarbonate level is within normal range, suggesting no metabolic compensation is present.
B. Metabolic acidosis would be indicated by a low pH and low bicarbonate level, which is not the case here since the bicarbonate is normal at 26 mEq/L.
C. Metabolic alkalosis would present with a high pH and high HCO3, which does not match these values.
D. Respiratory alkalosis would show a high pH and low PaCO2, which is contrary to the provided ABG results.
Correct Answer is D
Explanation
A. Furosemide is a diuretic and is not indicated in the acute management of anaphylaxis.
B. Methylprednisolone is a corticosteroid that may be used later to reduce inflammation but is not the first-line treatment in anaphylaxis.
C. Dobutamine is a medication used to treat heart failure and shock but does not address the acute allergic reaction.
D. Epinephrine is the first-line treatment for anaphylactic shock, as it acts quickly to reverse severe allergic reactions by causing vasoconstriction, bronchodilation, and inhibiting further release of mediators from mast cells.