A nurse is caring for a client who is taking lithium and reports starting a new exercise program.
The nurse should assess the client for which of the following electrolyte imbalances?

Drowsiness is a very common adverse effect of paroxetine, a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety. Paroxetine can cause somnolence (sleepiness) in up to 22% of patients who take it. The nurse should instruct the client to monitor for this effect and avoid driving or operating machinery until they know how the medication affects them.

Choice A is wrong because tinnitus (ringing in the ears) is not a common adverse effect of paroxetine.

It may occur rarely in some patients, but it is not a typical symptom of SSRI use.

Choice B is wrong because alopecia (hair loss) is not a common adverse effect of paroxetine.

It may occur rarely in some patients, but it is not a typical symptom of SSRI use.

Choice C is wrong because peripheral edema (swelling of the limbs) is not a common adverse effect of paroxetine.

It may occur rarely in some patients, but it is not a typical symptom of SSRI use.

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.