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) Internal fixation of a fractured hip. This procedure is associated with a higher risk of fat embolism syndrome (FES) due to the release of fat globules from the bone marrow into the bloodstream following trauma or surgery to long bones. The likelihood increases after orthopedic surgeries, especially in the hip and pelvis regions, where bone marrow is rich. Recognizing this risk is critical for monitoring and early intervention.
B) Repair of a torn rotator cuff. While this procedure involves surgery on the shoulder, it is not typically associated with a significant risk of fat embolism. The shoulder region does not contain the same volume of fatty tissue or bone marrow as the hip, making this option less likely to contribute to FES.
C) Thyroidectomy. This procedure is primarily focused on the thyroid gland in the neck and does not involve manipulation of large bones or fatty tissues, thus posing a minimal risk for fat embolism syndrome. It is more related to complications like hypoparathyroidism or nerve injury rather than fat embolism.
D) Tympanoplasty. This ear surgery involves repairing the eardrum and does not present a risk for fat embolism. The procedure is localized and does not involve significant manipulation of fatty tissues or large bones, making it unlikely to contribute to FES.
Correct Answer is C
Explanation
A) Spironolactone: Spironolactone is a potassium-sparing diuretic often used in heart failure and hypertension management. It is not indicated for allergic reactions or hives and does not address the symptoms caused by IV contrast dye.
B) Metoclopramide: Metoclopramide is an antiemetic medication used to treat nausea and vomiting. It is not effective for treating allergic reactions or urticaria, so this option is not appropriate in this context.
C) Diphenhydramine: Diphenhydramine is an antihistamine that is commonly used to treat allergic reactions, including hives and urticaria. Administering diphenhydramine will help alleviate the symptoms related to the adverse reaction to the IV contrast dye, making it the most appropriate medication to administer in this situation.
D) Desmopressin: Desmopressin is used to treat conditions such as diabetes insipidus and certain bleeding disorders. It has no role in treating allergic reactions or hives, making it an inappropriate choice for this scenario.