A nurse is reviewing arterial blood gas results for a client who has metabolic acidosis. Which of the following values should the nurse expect?

Furosemide is a loop diuretic commonly used in the management of heart failure to reduce fluid overload and improve cardiac function. It acts on the loop of Henle in the kidneys, promoting the excretion of sodium, chloride, and water. However, it also increases the loss of potassium and other electrolytes, which can lead to significant imbalances. Monitoring for adverse effects is essential to prevent complications such as cardiac dysrhythmias.

Rationale:
A. Hypoglycemia is not a typical adverse effect of furosemide. Diuretics can have metabolic effects, but loop diuretics do not directly lower blood glucose levels. In some cases, they may actually impair glucose tolerance rather than cause low blood sugar.

B. Hypokalemia is a common and clinically significant adverse effect of furosemide due to increased urinary excretion of potassium. Loss of potassium can lead to muscle weakness, cramps, and life-threatening cardiac dysrhythmias. Regular monitoring of serum potassium levels is essential during therapy.

C. Hyperchloremia is not associated with furosemide use. Loop diuretics typically cause loss of chloride along with sodium and potassium, which may lead to hypochloremia rather than elevated chloride levels. Therefore, this finding is inconsistent with the drug’s mechanism of action.

D. Hypernatremia is not a typical effect of furosemide. This medication promotes sodium excretion, which can lead to hyponatremia rather than elevated sodium levels. Fluid and electrolyte balance must be closely monitored to prevent complications from excessive sodium loss.

Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant organism that can be transmitted through direct contact, contaminated surfaces, or healthcare equipment. Maintaining medical asepsis is essential to prevent cross-contamination between clients, healthcare workers, and the environment. Hand hygiene is the most effective and fundamental infection control measure in preventing the spread of MRSA. Nurses must follow proper handwashing and standard precautions during all client care activities.

Rationale:
A. Rubbing hands with a 40% alcohol-based product is incorrect because effective alcohol-based hand sanitizers must contain at least 60% alcohol to achieve adequate antimicrobial activity. Lower concentrations are not sufficient to eliminate MRSA and may not provide reliable infection control. Proper hand hygiene requires approved antiseptic formulations.

B. Washing hands for at least 15 seconds before providing care is correct because proper hand hygiene mechanically removes microorganisms, including MRSA, from the hands. Soap and water are especially important when hands are visibly soiled or when dealing with resistant organisms. This reduces the risk of transmission and maintains medical asepsis during client care.

C. Providing the client with a mask during clinical visits is not necessary for MRSA unless there is a risk of respiratory droplet transmission, which is not typical for this organism. MRSA is primarily spread through direct contact, not airborne routes. Therefore, masking the client does not directly contribute to medical asepsis in this scenario.

D. Wearing a mask while providing ADLs for the client is not required for standard MRSA precautions unless there is a risk of splashing or aerosol-generating procedures. MRSA transmission is primarily contact-based, so the key protective measures include gloves and hand hygiene. A mask alone does not address the main route of transmission.