A nurse is caring for a client weighing 80\text{ kg} who is admitted with acute decompensa… — NCLEX-RN

A nurse is caring for a client weighing $80\text{ kg}$ who is admitted with acute decompensated heart failure. The client is receiving a continuous intravenous infusion of milrinone at $0.5\text{ mcg/kg/min}$ via a single patent 20-gauge peripheral IV line in the left forearm.

The client's respiratory status acutely worsens, with oxygen saturation dropping to 84% on room air and severe bilateral crackles present on auscultation. The healthcare provider prescribes a stat dose of furosemide $1\text{ mg/kg}$ IV push.

The available furosemide vial concentration is $10\text{ mg/mL}$ . Facility policy mandates that IV furosemide must not be administered faster than $20\text{ mg/min}$ to prevent ototoxicity.

After multiple unsuccessful attempts to establish a second peripheral IV line by the vascular access team, which of the following is the most appropriate action by the nurse?

Pause the milrinone infusion, flush the IV line with 0.9% sodium chloride, administer $8\text{ mL}$ of furosemide over a minimum of 4 minutes, flush the line again, and resume the milrinone.Answer
B
Administer $8\text{ mL}$ of furosemide via the lowest Y-site injection port over 4 minutes while the milrinone continues to infuse to prevent hemodynamic collapse.
C
Pause the milrinone infusion, clear the IV line with a flush, administer $4\text{ mL}$ of furosemide over 2 minutes, flush the line again, and resume the milrinone.
D
Request an immediate order for an intraosseous (IO) line, as it is unsafe to pause a continuous inotropic infusion for the time required to push the diuretic.

Answer

The nurse must pause the milrinone infusion, clear the line with a compatible flush, administer the correct volume of

8\text{ mL}

furosemide slowly over at least 4 minutes, flush again, and restart the milrinone.

The correct sequence prioritizes client safety by preventing a dangerous chemical incompatibility while delivering the exact calculated dose (

80\text{ mg}

8\text{ mL}

) over the required minimum time (4 minutes) to prevent ototoxicity. Pausing the milrinone temporarily is safe because its half-life is sufficiently long (2.3 to 2.4 hours) that a 5-minute pause will not precipitate immediate hemodynamic collapse, whereas untreated acute pulmonary edema is rapidly fatal.

Step-by-Step Solution

Calculate the total required dose based on the client's weight.

80\text{ kg} \times 1\text{ mg/kg} = 80\text{ mg}

of furosemide.

Accurate weight-based dosing is critical for therapeutic efficacy.

Calculate the volume of medication to administer.

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

Converts the ordered dose into the administrable liquid volume.

Determine the minimum safe administration time.

80\text{ mg} \div 20\text{ mg/min} = 4\text{ minutes}

Rapid administration of high-dose loop diuretics can cause permanent ototoxicity (hearing loss).

Assess IV compatibility and determine the administration sequence.

Milrinone and furosemide are incompatible. The nurse must use the stop-flush-push-flush-start sequence.

Mixing incompatible medications causes precipitation. When only one IV line is available, the continuous infusion must be temporarily paused and the line flushed before and after the push medication.

Key Concept

Management of incompatible intravenous medications and weight-based dosage calculations.

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