A nurse is preparing to administer furosemide 80 mg IV bolus… | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A nurse is preparing to administer furosemide 80 mg IV bolus to a 75-year-old client with pulmonary edema. The order does not specify a rate. Which action by the nurse is most appropriate?
1Administer the dose as a rapid IV push over 30 seconds to facilitate immediate diuresis for the acute pulmonary edema.
2Administer the dose IV at no faster than 4 mg per minute (≥20 minutes for 80 mg) to reduce the risk of ototoxicity.✓ Correct answer
3Withhold the dose and contact the provider to clarify the rate, as administering without a specified rate is unsafe.
4Dilute the dose in 50 mL of 5% dextrose solution and administer over 5 minutes to maximize the rate of diuresis.
Explanation
Furosemide IV rate — ototoxicity prevention Rapid IV administration of loop diuretics is the principal risk factor for ototoxicity (tinnitus, transient or permanent hearing loss). The recommended maximum rate is 4 mg/min for adult bolus dosing — for an 80 mg dose, that means at least 20 minutes (or as a continuous infusion). High-dose IV loop in renal impairment, with concurrent aminoglycosides, in elderly clients, or pre-existing hearing loss further increases risk. Furosemide should not be mixed with dextrose in the same syringe (compatibility issue) and is incompatible with many drugs — flush before/after. The nurse does NOT hold a critical medication for missing rate information; the standard rate is well established and the institutional policy can be applied. Pushing over 30 seconds risks ototoxicity. Patient should be on a cardiac monitor with hourly I/O, BP, and pulse oximetry during therapy.
In-depth explanation
Clinical reasoning summary Furosemide IV rate — ototoxicity prevention Rapid IV administration of loop diuretics is the principal risk factor for ototoxicity (tinnitus, transient or permanent hearing loss). The recommended maximum rate is 4 mg/min for adult bolus dosing — for an 80 mg dose, that means at least 20 minutes (or as a continuous infusion). High-dose IV loop in renal impairment, with concurrent aminoglycosides, in elderly clients, or pre-existing hearing loss further increases risk. Furosemide should not be mixed with dextrose in the same syringe (compatibility issue) and is incompatible with many drugs — flush before/after. The nurse does NOT hold a critical medication for missing rate information; the standard rate is well established and the institutional policy can be applied. Pushing over 30 seconds risks ototoxicity. Patient should be on a cardiac monitor with hourly I/O, BP, and pulse oximetry during therapy.