Practice Quiz

Respiratory Therapist

Category - Initiation and Modification of Interventions

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A patient recently diagnosed with COPD was started on Advair 250/50, one puff bid; ProAirHFA, two puffs qid; and furosemide, 40 mg bid. The patient is noncompliant with CPAP machine but has been diagnosed obstructive sleep apnea as well.

The patient has presented with dyspnea, weakness, nausea and vomiting. All routine lab work, ECG, and saturation have been ordered.

Based on the above, what imbalance would you expect, and what treatment recommendation is appropriate?
  1. Potassium is 2.0 mmol/L. Decrease diuretic and increase fluid intake
  2. Potassium is 6.0 mmol/L. Maintain diuretic and decrease fluid intake
  3. Calcium is 7.5 mg/dL. Decrease diuretic and increase fluid intake
  4. Calcium is 8.5 mg/dL. Maintain diuretic and decrease fluid intake
Explanation
Answer: A-A patient with the above symptoms could have an electrolyte workup to reveal a decreased potassium value. The diuretic should be decreased and fluid intake increased.

The furosemide is being given at a high dosage and frequency; and could be causing a sudden, severe electrolyte imbalance. The therapist should note the potassium level (normal range 3.5-5.0 mmoL/L) and recommend adjustment of the Lasix and fluid intake.
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