Pharmacology Antihypertensives #7

Question

The intensive care nurse is caring for a patient who needs a heart transplant and has low cardiac output and severe peripheral edema. Which diuretic should the nurse administer to help achieve fluid balance in this patient?

Answers

  1. Mannitol 0.25g/kg IV over 3 hours
    • Rationale:

      This answer is not correct because mannitol is used to decrease intracranial pressure, not decrease excessive fluid within the body. IV furosemide is most appropriate to restore low cardiac output and decrease fluid and edema.

  2. Furosemide 40 mg IV push over 10 minutes
    • Rationale:

      This answer is correct because furosemide is a diuretic used in conditions, such as when a patient needs a heart transplant and when cardiac output is low, which makes renal perfusion low. Intravenous furosemide is administered in this situation to help reduce the excessive sodium and water in the body and improve cardiac output. The infusion rate of the furosemide IV push should not exceed 4 mg/min, so the nurse infuses 40 mg over 10 minutes or more.

  3. Furosemide 20 mg po
    • Rationale:

      This answer is not correct because furosemide should be administered the IV (not PO) route due to the condition of the patient. The IV route is most appropriate to be able to restore cardiac output quickly.

  4. Hydrochlorothiazide 50 mg po
    • Rationale:

      This answer is not correct because hydrochlorothiazide’s dosage is too low and is the oral route. The IV route of furosemide is most appropriate to be able to restore cardiac output quickly.

Overview

Furosemide is a loop diuretic which reduces edema and excessive fluid volume in the body.

Explanation

The correct answer is B. When cardiac output is low, renal perfusion is low, and this signals the sympathetic nervous system to vasoconstrict and to conserve sodium and water. To overcome this problem, the nurse administers furosemide in an IV push, because loop diuretics function in low-cardiac output states. The infusion rate of the furosemide IV push should not exceed 4 mg/min, so the nurse infuses 40 mg over 10 minutes or more. Selection A is incorrect as it is used for decreasing intracranial pressure. Selection C is incorrect since a larger amount of furosemide is needed, and the condition of the client warrants IV route, not oral route. Selection D is incorrect as will not have the intended outcome since it is a lower dose, route is by mouth, and client’s cardiac output requires more aggressive measures. Oral medications will also take longer for action.

Learning Outcomes

Furosemide is a diuretic used in conditions when cardiac output is low, which makes renal perfusion low. Intravenous furosemide is administered to help reduce too much sodium and water in the body and improve cardiac output. The infusion rate of the furosemide IV push should not exceed 4 mg/min. Potassium levels should be monitored in the patient taking furosemide since the medication can cause hypokalemia. Periodic blood levels should be performed to check if the patient is within the normal range of 3.5-5.3 mEq/L.

Test Taking Tip

Always check the patient’s blood pressure and potassium levels when administering furosemide.

Video Rationale