A nurse is reinforcing discharge teaching with a client who has pulmonary edema and is about to start taking furosemide.
Which of the following instructions should the nurse include?

Eat foods that contain plenty of potassium.

Take the medication at bedtime.

Take aspirin for headaches.

Expect some swelling in the hands and feet.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

The nurse should instruct the client to consume foods rich in potassium because furosemide, a loop diuretic, can lead to potassium depletion. By consuming potassium-rich foods, the client can help maintain proper electrolyte balance. Common potassium-rich foods include bananas, oranges, potatoes, and leafy greens. It is crucial to prevent hypokalemia, as it can result in adverse effects such as cardiac dysrhythmias and muscle weakness.

Choice B rationale:

Taking furosemide at bedtime is not necessary, and it is not a standard instruction. Furosemide is usually taken in the morning to avoid nocturia, as it increases urine output. This option does not address the primary concern of managing pulmonary edema and the potential electrolyte imbalances associated with furosemide use.

Choice C rationale:

Taking aspirin for headaches is not relevant to the client's condition of pulmonary edema or the use of furosemide. This choice does not provide valuable guidance to the client and may lead to unnecessary medication use.

Choice D rationale:

Expecting swelling in the hands and feet is not an appropriate instruction for a client with pulmonary edema. The goal of furosemide therapy is to reduce edema and fluid retention, not to expect or tolerate swelling. This option does not contribute to the client's well-being and recovery.

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Correct Answer is D

Explanation

Choice A rationale:

Having the client cough and expectorate secretions is a reasonable intervention for managing respiratory distress, but it is not the top priority. The nurse should first assess the client's overall respiratory status to determine the severity of the problem.

Choice B rationale:

Instructing the client to use a pursed-lip breathing technique is a helpful strategy to improve breathing in some cases. However, it should not be the top priority when a client is experiencing difficulty breathing. Assessment should come first.

Choice C rationale:

Increasing the oxygen flow to 3 L/min without a proper assessment is not advisable. It's essential to evaluate the client's respiratory status before making any adjustments to the oxygen therapy.

Choice D rationale:

"Evaluate the client's respiratory status" is the correct response. When a client with COPD and oxygen therapy reports difficulty breathing, the nurse's priority is to assess the client's respiratory status. This assessment will help determine the cause of the breathing difficulty and guide appropriate interventions. The nurse should also check the oxygen saturation levels, respiratory rate, and auscultate lung sounds to assess the severity of the issue.

A. "Lifelong treatment with this medication is necessary.”. B. "The medication causes amenorrhea if taken along with an oral contraceptive.”. C. "You should wear glasses instead of contacts while taking this medication.”. D. "A yellow tint to the skin is an expected reaction to the medication.”.

Correct Answer is A

Explanation

Choice A rationale:

The nurse should include the statement, "Lifelong treatment with this medication is necessary.”. This is because rifampin is often part of a multidrug regimen used to treat tuberculosis, and treatment typically lasts for several months, sometimes up to a year. It is crucial for the client to understand the need for long-term treatment to ensure the successful eradication of the tuberculosis bacteria from their system.

Choice B rationale:

The statement, "The medication causes amenorrhea if taken along with an oral contraceptive," is not accurate. Rifampin is known to interact with oral contraceptives, decreasing their effectiveness, but it does not directly cause amenorrhea. The correct teaching should focus on the need for alternative or additional contraceptive methods while taking rifampin.

Choice C rationale:

The statement, "You should wear glasses instead of contacts while taking this medication," is not directly related to rifampin. Rifampin can cause certain ocular side effects, but it does not necessarily require the client to switch from contacts to glasses. This advice would depend on the individual's eye health and any specific concerns.

Choice D rationale:

The statement, "A yellow tint to the skin is an expected reaction to the medication," is incorrect. While rifampin can cause a harmless side effect of orange-red discoloration of body fluids, such as urine, sweat, and tears, it does not typically cause a yellow tint to the skin. The nurse should clarify this misconception with the client.

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A nurse is reinforcing discharge teaching with a client who has pulmonary edema and is about to start taking furosemide.Which of the following instructions should the nurse include?

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A nurse is reinforcing discharge teaching with a client who has pulmonary edema and is about to start taking furosemide.
Which of the following instructions should the nurse include?