A nurse is caring for a client who is taking sertraline and reports a desire to begin taking supplements.
Which of the following supplements should the nurse advise the client to avoid?

According to the CDC, people with severe, life-threatening allergies to any ingredient in a flu vaccine (other than egg proteins) should not get that vaccine. However, people with egg allergy can get a flu vaccine. The CDC also states that people who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. Therefore, a nurse should report an egg allergy to the provider as a possible contraindication to receiving the vaccine.

Choice A is wrong because shellfish is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.

Choice C is wrong because milk is not an ingredient in a flu vaccine and is not a contraindication to receiving the vaccine.

Choice D is wrong because peanuts are not an ingredient in a flu vaccine and are not a contraindication to receiving the vaccine.

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.