A nurse is caring for a client who has heart failure and is taking hydrochlorothiazide. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication?

Choice A Reason:
Dark amber urine is incorrect. Dark urine can indicate concentrated urine, often seen in dehydration when the body is trying to conserve water.
Choice B Reason:
Decreased skin turgor is incorrect. Decreased skin turgor is a classic sign of dehydration, indicating that the skin lacks elasticity due to insufficient fluid intake or loss.
Choice C Reason:
Pink, frothy sputum is correct. Normal saline is a common intravenous solution used to treat dehydration. However, in some cases, especially when administered in excessive amounts, it can lead to fluid overload or pulmonary edema. This can manifest as pink, frothy sputum, indicating potential pulmonary congestion or edema, which is a serious adverse effect of fluid overload.
Choice D Reason:
Increased bowel sounds is incorrect. Increased bowel sounds can be seen in various conditions, including gastrointestinal disturbances or hyperactive bowel motility, but it's not typically associated with the adverse effects of normal saline administration.

Choice A Reason:
"I will check the client's INR before administering the heparin." is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps reduce the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in minimizing bleeding at the injection site.