Question

The nurse is admitting an older adult with decompensated congestive heart failure. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. The nurse should question which doctor's order?

A. KCl 20 mEq PO two times per day
B. Intravenous (IV) 500 mL of 0.9% NaCl at 125 mL/hr
C. Oxygen via face mask at 8 L/min
D. Furosemide (Lasix) 20 mg PO now

Answer 1

The nurse should question the order for IV 500 mL of 0.9% NaCl at 125 mL/hr in a patient with decompensated congestive heart failure due to risk of worsening fluid overload and pulmonary edema.

Step-by-step explanation:

The nurse should question the doctor's order for IV 500 mL of 0.9% NaCl at 125 mL/hr. In a patient with decompensated congestive heart failure (CHF), administering a large volume of IV fluids can exacerbate fluid overload, potentially worsening pulmonary edema, which is indicated by adventitious lung sounds and orthopnea.

The other orders, KCl 20 mEq PO, Oxygen via face mask at 8 L/min, and Furosemide (Lasix) 20 mg PO now, are typical treatments for CHF and electrolyte management, and to alleviate symptoms of dyspnea and fluid retention, respectively. However, given the patient's condition, careful fluid management is essential to avoid increasing the cardiac workload and exacerbating CHF symptoms.