A nurse is caring for a client who has breast cancer and reports pain 1 hr after administration of prescribed morphine 10 mg IV.
Which of the following medications should the nurse expect to administer?

Furosemide is a diuretic that is used to treat heart failure by reducing fluid retention and lowering blood pressure. It can cause some side effects, such as increased urination, thirst, dry mouth, headache, dizziness, nausea, and electrolyte imbalance.

Choice A is wrong because BUN (blood urea nitrogen) is a measure of kidney function and a normal range is 7 to 20 mg/dL.

A BUN of 15 mg/dL is not a cause for concern and does not indicate any adverse effect of furosemide.

Choice C is wrong because potassium is an electrolyte that is important for nerve and muscle function and a normal range is 3.5 to 5.0 mEq/L.

Potassium of 3.8 mEq/L is within the normal range and does not indicate any adverse effect of furosemide. However, furosemide can cause low potassium levels (hypokalemia) in some cases, so the nurse should monitor the client’s potassium levels regularly and advise the client to eat foods rich in potassium, such as bananas, oranges, and potatoes.

Choice D is wrong because dizziness upon standing is a common side effect of furosemide and does not require immediate notification of the provider. However, the nurse should instruct the client to rise slowly from a sitting or lying position to prevent falls and to drink enough fluids to prevent dehydration.

Choice B is correct because difficulty hearing or hearing loss is a rare but serious side effect of furosemide that may indicate ototoxicity (damage to the inner ear). This can be irreversible if not treated promptly and may affect the client’s quality of life and safety. The nurse should notify the provider immediately if the client reports difficulty hearing or any other signs of ototoxicity, such as ringing in the ears (tinnitus) or vertigo (a sensation of spinning). The provider may need to adjust the dose of furosemide or switch to another diuretic that is less ototoxic.

This is because hydromorphone is a controlled substance and any unused portion should be discarded in the presence of a witness. Some possible explanations for the other choices are:

Choice A is wrong because storing the remaining half of the pill in the automated medication dispensing system could lead to errors in dosage or diversion of the drug.

Choice C is wrong because returning the remaining medication to the facility’s pharmacy is not a recommended practice for controlled substances and could also result in errors or diversion.

Choice D is wrong because placing the remaining half of the pill in the unit-dose package could compromise the integrity and stability of the medication and expose it to environmental factors.

Normal ranges for hydromorphone are not applicable as it is a synthetic opioid analgesic that does not have a therapeutic level.

However, some factors that may affect its pharmacokinetics and pharmacodynamics are age, weight, renal function, liver function, genetic polymorphisms, and drug interactions.