Pediatric Exam Question Regarding Lasix and Furosemide

  1. For the following question, my classmates and I have established contradicting answers and I'm wondering if I can get some input regarding the answer choices.

    I will explain my rationale in hopes that someone can explain why it would be correct or incorrect.

    The nurse is caring for a child with VSD who is receiving Lasix and Digoxin. Which of the following nursing diagnosis is appropriate due to the medications the child is on?

    a. Fluid volume overload
    b. Potential electrolyte imbalance
    c. Potential for imbalanced nutrition
    d. Ineffective breathing pattern

    I would go with B. only because due to the medications (specifically Lasix) they are at risk of fluid volume deficit but loss of potassium because it is non-potassium sparing. Also, digoxin toxicity risk increases if the patient is hypokalemic so electrolyte monitoring is HUGE. The key for me here was that the professor highlighted DUE TO the medications. I would be interested in any input! Thank you
    Last edit by Joe V on Apr 4
  2. Poll: Which answer would you have gone with?

    • A

      33.33% 8
    • B

      66.67% 16
    • C

      0% 0
    • D

      0% 0
    24 Votes
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    14 Comments

  4. by   ItsThatJenGirl
    My answer would be B.
  5. by   smf0903
    When I was in school we weren't allowed to give a "risk for" diagnosis as a first pick because there was always something actually going on at the moment. In that spirit, I would actually pick A.
  6. by   OcMurse93
    I would pick A. One, I think the teacher was leaning more towards, given the medications-what nursing diagnosis is likely, versus what nursing diagnosis would be appropriate for a child with VSD.

    And two, an actual nursing diagnosis trumps a potential.

    Three- you're reading too much into the question. The question doesn't say anything about the digoxin dose or even mentions toxicity.
  7. by   ItsThatJenGirl
    Quote from smf0903
    When I was in school we weren't allowed to give a "risk for" diagnosis as a first pick because there was always something actually going on at the moment. In that spirit, I would actually pick A.
    But what does that have to do with the medications? Not being argumentative, trying to learn.
  8. by   OcMurse93
    Quote from ItsThatJenGirl
    But what does that have to do with the medications? Not being argumentative, trying to learn.
    Totally. It sounds like a textbook NCLEX question. Which answer is MORE correct.

    In terms of fluid volume excess, the patient is taking Lasix. That counteracts FVE. So it makes sense that a patient has too much fluid if they are taking lasix, otherwise why would they be receiving it?

    Lasix can sometimes cause hypokalemia, but not always. Just like Digoxin can cause Hyperkalemia, but not always. Potential for electrolyte imbalance fits for this.

    So when it comes down to it, you simply apply the actual trumps potential diagnosis rule. Also as i mentioned earlier, the "due to", i think, is messing with you. The teacher wants (I think) a diagnosis that is related to the medications, not the disease itself. If you look at D then that could also be an answer because it is related to the VSD, but is excluded because the patient isnt taking medication for this reason.

    I could be totally wrong, but that was how I read it.
  9. by   OneWhisper
    Quote from OcMurse93
    Totally. It sounds like a textbook NCLEX question. Which answer is MORE correct.

    In terms of fluid volume excess, the patient is taking Lasix. That counteracts FVE. So it makes sense that a patient has too much fluid if they are taking lasix, otherwise why would they be receiving it?

    Lasix can sometimes cause hypokalemia, but not always. Just like Digoxin can cause Hyperkalemia, but not always. Potential for electrolyte imbalance fits for this.

    So when it comes down to it, you simply apply the actual trumps potential diagnosis rule. Also as i mentioned earlier, the "due to", i think, is messing with you. The teacher wants (I think) a diagnosis that is related to the medications, not the disease itself. If you look at D then that could also be an answer because it is related to the VSD, but is excluded because the patient isnt taking medication for this reason.

    I could be totally wrong, but that was how I read it.
    That's exactly how I read it as well. You explained it exactly how I was thinking it! But, I could be wrong too!

    The OP didn't say what the instructor said was the correct answer?
  10. by   ItsThatJenGirl
    Quote from OcMurse93
    Totally. It sounds like a textbook NCLEX question. Which answer is MORE correct.

    In terms of fluid volume excess, the patient is taking Lasix. That counteracts FVE. So it makes sense that a patient has too much fluid if they are taking lasix, otherwise why would they be receiving it?

    Lasix can sometimes cause hypokalemia, but not always. Just like Digoxin can cause Hyperkalemia, but not always. Potential for electrolyte imbalance fits for this.

    So when it comes down to it, you simply apply the actual trumps potential diagnosis rule. Also as i mentioned earlier, the "due to", i think, is messing with you. The teacher wants (I think) a diagnosis that is related to the medications, not the disease itself. If you look at D then that could also be an answer because it is related to the VSD, but is excluded because the patient isnt taking medication for this reason.

    I could be totally wrong, but that was how I read it.
    I understand the rationale to choose the most relevant answer relating to the diagnosis, but wouldn't that also be ineffective breathing pattern? And why would "due to" be bolded (or even mentioned at all)? The only reason I chose B was because of the due to, otherwise I wouldn't have known how to choose between the breathing and the fluid overload. I'm only in my first semester, and these questions always confuse me.
  11. by   smf0903
    Quote from ItsThatJenGirl
    But what does that have to do with the medications? Not being argumentative, trying to learn.
    I wouldn't take that as argumentative at all

    I would have written almost verbatim what OcMurse wrote. Actual trumps a risk for/potential, and the patient is taking lasix which means they are in overload. Nowhere does it say anything about fluid overload affecting their breathing (could be peripheral edema that they're trying to combat with the lasix...either way, ineffective breathing pattern is adding/assuming information that isn't in the question. Once you start thinking outside of the information presented in the NCLEX world you get a wrong answer LOL.

  12. by   ItsThatJenGirl
    Quote from smf0903
    I wouldn't take that as argumentative at all

    I would have written almost verbatim what OcMurse wrote. Actual trumps a risk for/potential, and the patient is taking lasix which means they are in overload. Nowhere does it say anything about fluid overload affecting their breathing (could be peripheral edema that they're trying to combat with the lasix...either way, ineffective breathing pattern is adding/assuming information that isn't in the question. Once you start thinking outside of the information presented in the NCLEX world you get a wrong answer LOL.

    But in patients with VSD, the fluid volume overload is caused by the pumping of the blood into lungs because of the septum defect, isn't it, which would make the ineffective breathing pattern the priority, no? That's why I'm so confused. I swear nursing school is making me dumber. Thanks for talking me through this
  13. by   OcMurse93
    Quote from ItsThatJenGirl
    But in patients with VSD, the fluid volume overload is caused by the pumping of the blood into lungs because of the septum defect, isn't it, which would make the ineffective breathing pattern the priority, no? That's why I'm so confused. I swear nursing school is making me dumber. Thanks for talking me through this
    In your defense, this question isn't worded the best. As someone who just recently took the NCLEX I can safely say that all of the questions were not difficult to understand or had any weird wording at all.

    Im not super familiar with VSD's but if you have too much fluid overloading your lungs, you might either have pulmonary hypertension or maybe even pulmonary edema. Neither of these would cause an ineffective breathing PATTERN. Impaired gas exchange perhaps, but not ineffective breathing pattern.

    edit: also, lets assume that you were correct and the excess fluid is causing the ineffective breathing pattern. The primary issue is the fluid, which is causing a secondary issue- ineffective breathing. Therefore you would still pick fluid volume overload
    Last edit by OcMurse93 on Apr 1 : Reason: afterthought
  14. by   ItsThatJenGirl
    Quote from OcMurse93
    In your defense, this question isn't worded the best. As someone who just recently took the NCLEX I can safely say that all of the questions were not difficult to understand or had any weird wording at all.

    Im not super familiar with VSD's but if you have too much fluid overloading your lungs, you might either have pulmonary hypertension or maybe even pulmonary edema. Neither of these would cause an ineffective breathing PATTERN. Impaired gas exchange perhaps, but not ineffective breathing pattern.

    edit: also, lets assume that you were correct and the excess fluid is causing the ineffective breathing pattern. The primary issue is the fluid, which is causing a secondary issue- ineffective breathing. Therefore you would still pick fluid volume overload
    Okay, that makes sense - thank you!
  15. by   Here.I.Stand
    Which of the following nursing diagnosis is appropriate due to the medications the child is on?
    I would choose B. The child is at risk for all four answers; however the other risks are due to the VSD -- not the meds.

    A left-to-right shunt results in excess fluid through the pulmonary artery, pulmonary edema develops which creates an ineffective breathing pattern, and the ensuing fatigue can cause feeding difficulties leading to imbalanced nutrition.

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