A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?

A. Hyponatremia: Hyponatremia is characterized by low sodium levels in the blood and can lead to symptoms such as weakness, confusion, and seizures. While hyponatremia can contribute to fluid imbalance, the client's presentation with shortness of breath, lower extremity swelling, crackles in the lungs, and elevated blood pressure is more indicative of fluid volume excess rather than hyponatremia.

B. Hypervolemia: Hypervolemia, or fluid volume excess, occurs when there is an abnormal increase in the extracellular fluid volume. This can lead to symptoms such as shortness of breath, crackles in the lungs (indicative of pulmonary edema), peripheral edema, and elevated blood pressure. Given the client's reported symptoms and assessment findings, hypervolemia is the most likely diagnosis.

C. Hypovolemia: Hypovolemia, or fluid volume deficit, occurs when there is a decrease in the extracellular fluid volume. This condition is characterized by symptoms such as thirst, dry mucous membranes, decreased urine output, and hypotension. The client in this scenario presents with signs and symptoms consistent with fluid volume excess rather than hypovolemia.

D. Hyperkalemia: Hyperkalemia is characterized by elevated potassium levels in the blood and can lead to symptoms such as muscle weakness, cardiac dysrhythmias, and nausea. While hyperkalemia can occur in clients with end-stage kidney disease, the client's reported symptoms and assessment findings are more suggestive of fluid volume excess rather than hyperkalemia.

A) "You will have control of administering your own pain medication":
This statement accurately describes the function of a PCA (Patient-Controlled Analgesia) device, where the client has control over administering their own pain medication within preset limits. Empowering the client to manage their pain helps promote autonomy and individualized pain management.

B) "The pain medication is delivered into your muscle":
This statement is incorrect because PCA devices typically deliver medication intravenously, not into the muscle. It's important for the client to understand the route of administration to use the device effectively and safely.

C) "Your partner can push the PCA button for you if you are asleep":
Allowing someone else to activate the PCA button for the client can lead to overmedication and is not recommended. PCA devices are designed for the client to self-administer medication based on their own pain experience and need.

D) "A large dose of pain medication is given with each injection":
This statement is inaccurate because PCA devices are programmed to deliver a controlled dose of medication with each activation, usually within safe limits set by the healthcare provider. The doses are typically set to avoid overdosing while providing effective pain relief.