The nurse is preparing to administer furosemide (Lasix) 40 mg IV to a client on complete bed rest who has renal failure and pulmonary edema. Which action is most appropriate prior to administering furosemide (Lasix) to this client?

Question

1. Measure the client's urine output.
2. Monitor apical heart rate and rhythm.
3. Auscultate bowel sounds.
4. Lower the head of the bed.

Answer 1

Correct Answer: 2
Rationale 1: Intravenous furosemide (Lasix) causes rapid and profuse diuresis, and an accurate measurement of urine output following administration of this drug is necessary to evaluate the client's response to the drug. It is not necessary to measure urine output prior to administering the medication.
Rationale 2: Furosemide (Lasix) can cause a decrease in serum potassium and precipitate cardiac dysrhythmias.
Rationale 3: There is no reason to do a focused assessment of the gastrointestinal system. A focused assessment of the respiratory system would be more appropriate due to the fluid retention.
Rationale 4: Body positioning does not inhibit a therapeutic effect or prevent adverse effects of furosemide (Lasix), and raising the head of the bed promotes comfort for a client with pulmonary edema.
Global Rationale: Furosemide (Lasix) can cause a decrease in serum potassium and precipitate cardiac dysrhythmias. Intravenous furosemide (Lasix) causes rapid and profuse diuresis, and an accurate measurement of urine output following administration of this drug is necessary to evaluate the client's response to the drug. It is not necessary to measure urine output prior to administering the medication. There is no reason to do a focused assessment of the gastrointestinal system. A focused assessment of the respiratory system would be more appropriate due to the fluid retention. Body positioning does not inhibit a therapeutic effect or prevent adverse effects of furosemide (Lasix), and raising the head of the bed promotes comfort for a client with pulmonary edema.