A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which of the following assessment findings indicates to the nurse that the medication is effective?
Elevation in blood pressure
Respiratory rate of 24/min
Adventitious breath sounds
Weight loss of 1.8 kg (4 lb) in the past 24 hr
The Correct Answer is D
A) Elevation in blood pressure: An elevation in blood pressure is not an indicator of the effectiveness of furosemide. In fact, effective diuresis would typically lead to a reduction in blood pressure, especially in cases of pulmonary edema related to heart failure.
B) Respiratory rate of 24/min: A respiratory rate of 24/min indicates tachypnea, which is often associated with respiratory distress or ongoing pulmonary congestion. This finding does not suggest that the furosemide is effective; instead, it may indicate that further intervention is needed.
C) Adventitious breath sounds: The presence of adventitious breath sounds, such as wheezing or crackles, suggests ongoing fluid accumulation in the lungs and is not an indicator of effective diuresis. Effective treatment should lead to clearer breath sounds as fluid is removed.
D) Weight loss of 1.8 kg (4 lb) in the past 24 hr: This finding is a strong indicator of the effectiveness of furosemide. A significant weight loss, especially in a client with pulmonary edema, reflects a reduction in fluid overload. Since furosemide works by promoting diuresis, this weight loss suggests that the medication is effectively reducing excess fluid in the body.
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Correct Answer is A
Explanation
A) Glycosylated hemoglobin level: The glycosylated hemoglobin (HbA1c) level is the most reliable indicator of long-term glycemic control in clients with diabetes mellitus. It reflects average blood glucose levels over the past 2 to 3 months, allowing healthcare providers to assess how well the treatment plan is working over time.
B) Oral glucose tolerance test results: The oral glucose tolerance test (OGTT) is primarily used for diagnosing diabetes rather than monitoring long-term control. It assesses how well the body processes glucose but does not provide an ongoing measure of glycemic control.
C) Postprandial blood glucose level: While monitoring postprandial blood glucose (the blood glucose level after meals) is important for managing daily glucose levels, it does not give a long-term perspective on glycemic control. This measurement can fluctuate significantly based on diet and activity levels.
D) Fasting blood glucose level: The fasting blood glucose level is useful for assessing daily glucose control, but it does not provide a comprehensive view of long-term glycemic management over months like the HbA1c level does.
Correct Answer is D
Explanation
A) "It is normal to feel this way after a morning run.": While some fatigue can be expected after exercise, the client's symptoms of diaphoresis, palpitations, and exhaustion suggest that there may be an underlying issue related to their diabetes management, such as hypoglycemia. This response downplays the seriousness of their symptoms.
B) "It becomes easier when exercise is a routine.": While it is true that regular exercise can improve fitness and make physical activity feel easier over time, this response does not address the immediate concern of the client's current symptoms, which could indicate hypoglycemia.
C) "Were you careful to not have carbohydrates after the run?": This response suggests a misunderstanding of the client's needs. After exercise, especially for someone with type 1 diabetes, it is important to ensure adequate carbohydrate intake to prevent hypoglycemia. The client may need carbohydrates rather than avoiding them.
D) "Did you decrease your insulin intake before you exercised?": This is the most appropriate response. Clients with type 1 diabetes need to manage their insulin levels carefully, especially around exercise. If the client did not adjust their insulin dose or carbohydrate intake appropriately, they could be at risk for hypoglycemia, which explains their symptoms. This question encourages the client to reflect on their diabetes management in relation to their exercise.