A nurse is caring for a client with acute decompensated heart failure who is experiencing … — NCLEX-RN

A nurse is caring for a client with acute decompensated heart failure who is experiencing severe dyspnea and pulmonary edema. The healthcare provider prescribes furosemide $80\text{ mg}$ intravenous (IV) push STAT. The medication is supplied in a vial containing $10\text{ mg/mL}$ . The client currently has a single peripheral IV line infusing a continuous amiodarone drip. Which of the following actions is most appropriate for the nurse to take?

Establish a new peripheral IV access site and administer $8\text{ mL}$ of the medication over a duration of 4 minutes.Answer
B
Establish a new peripheral IV access site, administer the $8\text{ mL}$ dose over 4 minutes, and delegate the post-administration lung sound assessment to the unlicensed assistive personnel (UAP).
C
Calculate the required dose as $0.8\text{ mL}$ and administer it slowly through a newly established peripheral IV access site.
D
Administer the $8\text{ mL}$ dose over 4 minutes into the lowest Y-site port of the continuous amiodarone infusion line.

Answer

Establish a new peripheral IV access site and administer

8\text{ mL}

of the medication over a duration of 4 minutes.

The correct action comprehensively addresses all nursing safety principles for this scenario. First, the dose is correctly calculated as

8\text{ mL}

(

\frac{80\text{ mg}}{10\text{ mg/mL}} = 8\text{ mL}

). Second, to prevent ototoxicity, high-dose IV furosemide must be administered no faster than

20\text{ mg/min}

, which requires a 4-minute push for an

80\text{ mg}

dose. Third, because furosemide and amiodarone are physically incompatible and will form a precipitate, establishing a separate, secondary IV access is mandatory to ensure client safety.

Step-by-Step Solution

Calculate the required volume of medication to draw up.

Using the formula

\frac{\text{Desired}}{\text{Have}} \times \text{Volume}

, calculate

\frac{80\text{ mg}}{10\text{ mg}} \times 1\text{ mL} = 8\text{ mL}

Accurate dosage calculation is essential to ensure the client receives the therapeutic dose without risking toxicity.

Determine the safe IV push rate for the medication.

Furosemide is typically administered at a maximum rate of

20\text{ mg/min}

. Therefore, an

80\text{ mg}

dose must be pushed over at least 4 minutes.

Administering high doses of IV furosemide too rapidly greatly increases the risk of permanent ototoxicity (tinnitus and hearing loss).

Evaluate the physical compatibility of the prescribed medication with the existing continuous IV infusion.

Identify that furosemide is incompatible with amiodarone, meaning they cannot be infused through the same IV tubing.

Administering incompatible medications together causes precipitate formation, which blocks the IV line and can cause a fatal embolism.

Formulate a safe and appropriate administration plan.

Decide to start a second, separate peripheral IV line to administer the furosemide independently, and plan to personally assess the client's respiratory status afterward.

This comprehensively addresses all safety parameters: accurate dosing, appropriate speed, chemical compatibility, and proper scope of nursing practice.

Key Concept

Safe administration of high-alert parenteral medications

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