After administering furosemide to a 16-month-old child who has congestive heart failure, a nurse would expect to make which of the following observations?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

Furosemide is a potent loop diuretic whose primary mechanism is to inhibit the reabsorption of sodium and water in the kidneys.
In congestive heart failure (CHF), the goal of furosemide is to induce diuresis (increased urine production) to remove excess fluid from the body.
This reduction in fluid volume decreases the workload on the heart and alleviates symptoms of congestion.
Therefore, a significant increase in urine output is the most direct, immediate, and expected therapeutic outcome after administering the drug.

Option A: While furosemide helps clear fluid from the lungs, which can improve breath sounds, rhonchi are typically caused by secretions in larger airways, not fluid in the alveoli (which causes crackles). Also, improvement in breath sounds is a secondary effect that occurs after diuresis, not the primary observation.
Option B: A 20 mm Hg decrease in systolic blood pressure is a significant drop, especially in a child. This would be considered an adverse effect (hypotension) due to excessive fluid loss, not an expected therapeutic outcome.
Option C: An increase in heart rate (tachycardia) is not a desired effect. It is often a compensatory mechanism for a drop in blood pressure or a sign of an electrolyte imbalance (like hypokalemia), both of which are potential complications of diuretic therapy.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Pharmacology: Diuretic Therapy in Pediatric Heart Failure in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's primary responsibility after administering a diuretic is to monitor for its therapeutic effect, which is increased urine output. This confirms the medication is working as intended.
Failure to produce adequate urine after a diuretic may signal worsening renal function or that the dose is ineffective, requiring prompt notification of the physician.
Nurses must also vigilantly monitor for adverse effects like hypotension, tachycardia, and electrolyte imbalances (especially hypokalemia), which are common with loop diuretics.

How to Approach the Question

First, identify the key elements of the question: a 16-month-old child with congestive heart failure is given furosemide.
Recall the drug class and primary action of furosemide. It is a loop diuretic, and its main purpose is to cause diuresis (increase urine output).
The question asks for an expected observation. This implies the intended, therapeutic effect of the drug, not a side effect or complication.
Evaluate each option based on this understanding:
Is it the primary therapeutic effect? (Increased urine output)
Is it a secondary therapeutic effect? (Improved breath sounds)

Concept Tested & Keywords

Concept Tested: Pharmacology: Diuretic Therapy in Pediatric Heart Failure
Stem keywords: furosemide, 16-month-old, congestive heart failure, expect to observe
Lead-in keywords: expect
Clinical cues: Patient age: 16-month-old (pediatric considerations)
Clinical cues: Diagnosis: Congestive Heart Failure (indicates fluid overload)

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 pp. 46-48, 36-38, 32-34

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Attempt every question from this paper in a timed mock, then review the full solution for each one.