An adult with acute pulmonary edema has a prescription for furosemide 80 mg IV. Which administration plan best reduces the risk of ototoxicity?
1Infuse at no more than 4 mg/min, taking at least 20 minutes to give the dose.✓ Correct answer
2Give the entire dose by rapid IV push over 30 seconds for the fastest diuresis.
3Dilute the dose and infuse it over 5 minutes because dilution prevents hearing injury.
4Delay the dose until pulmonary symptoms resolve because all IV furosemide is ototoxic.
Explanation
Rapid IV furosemide administration increases the risk of tinnitus and reversible or irreversible hearing impairment. A controlled infusion rate no faster than 4 mg/min means an 80 mg dose should take at least 20 minutes.
Why this is correct Furosemide-associated ototoxicity is more likely with rapid injection, high doses, or renal impairment. The labeled controlled-infusion ceiling is 4 mg/min; 80 divided by 4 equals 20 minutes.
Easy analogy or mental picture The total dose is the distance and 4 mg/min is the speed limit.
Memory hook IV furosemide: four milligrams per minute or slower.
NCLEX decision rule For an IV medication with a labeled maximum rate, calculate the minimum administration time before giving the dose.
Why the other choices are wrong Rapid push and a 5-minute infusion exceed the rate ceiling; delaying indicated therapy does not follow the prescription or solve the administration risk.
References
1DailyMed: Furosemide injectionOtotoxicity warning and controlled IV infusion rate