A nurse is preparing to administer darbepoetin 0.45 mcg/kg subcutaneous once weekly to a client who weighs 198 lb. The amount available is Darbepoetin 300 mcg/mL. How many mL should the nurse administer?
(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A reason: This choice is incorrect because stomach distension and constipation are not common side effects of furosemide. They may be related to other causes, such as diet, fluid intake, or medication interactions. The nurse should assess the client's abdominal status and bowel habits and provide appropriate interventions, such as increasing fiber, fluids, or laxatives.

Choice B reason: This choice is incorrect because IV site irritation, redness, and pain are not specific side effects of furosemide. They may be caused by other factors, such as infection, infiltration, or phlebitis. The nurse should inspect the IV site and catheter and change them if needed. The nurse should also monitor the client's vital signs and blood cultures for signs of infection.

Choice C reason: This choice is correct because hearing loss or impairment is a rare but serious side effect of furosemide. It can occur due to damage to the inner ear or the auditory nerve. It may be temporary or permanent, depending on the dose and duration of furosemide therapy. The nurse should stop the infusion of furosemide and notify the provider immediately. The nurse should also assess the client's hearing and balance and provide safety measures.

Choice D reason: This choice is incorrect because frequent urination is an expected effect of furosemide. Furosemide is a diuretic that increases the excretion of water and electrolytes through the urine. It helps to reduce fluid overload and edema in clients with heart failure. The nurse should measure and record the client's intake and output and monitor the client's fluid and electrolyte status.

Choice A reason: This choice is incorrect because checking the apical heart rate before taking calcium channel blockers is not necessary for most patients. Calcium channel blockers are a group of medications that relax and widen blood vessels, lower blood pressure, and slow the heart rate. They are used to treat conditions such as hypertension, angina, and arrhythmias. The nurse should check the apical heart rate only if the patient has a history of bradycardia (slow heart rate) or heart block (a problem with the electrical conduction of the heart).

Choice B reason: This choice is incorrect because calcium channel blockers do not cause increased blood pressure, but rather lower it. Blurred vision is not a common side effect of calcium channel blockers, and it may indicate other problems, such as eye infection, glaucoma, or stroke. The nurse should instruct the patient to report any changes in vision, but not to associate them with calcium channel blockers.

Choice C reason: This choice is incorrect because calcium channel blockers do not affect cholesterol levels, and the time of day they are taken does not matter. Cholesterol is a type of fat that circulates in the blood and can build up in the arteries, causing atherosclerosis (hardening and narrowing of the arteries). Cholesterol levels are influenced by diet, exercise, genetics, and other medications, such as statins. The nurse should advise the patient to follow a healthy lifestyle and take any prescribed medications for cholesterol control.

Choice D reason: This choice is correct because grapefruit juice can interact with some calcium channel blockers, such as nifedipine, verapamil, and diltiazem, and increase their blood levels and effects. This can cause serious side effects, such as low blood pressure, dizziness, headache, flushing, and edema (swelling). The nurse should warn the patient to avoid grapefruit juice and any products that contain grapefruit while taking calcium channel blockers.