A nurse is reviewing the results of electrocardiography monitoring for a client who has atrial fibrillation. Which of the following findings should the nurse expect?

A. "I will take ibuprofen for mild pain": NSAIDs like ibuprofen can lead to sodium and fluid retention, which can exacerbate heart failure by increasing preload and worsening edema. They can also reduce the effectiveness of diuretics and ACE inhibitors, both of which are commonly used in heart failure management. Acetaminophen is generally preferred for pain relief as it does not contribute to fluid retention.

B. "I will weigh myself every other day": Daily weight monitoring is essential for detecting fluid retention early, as a sudden increase of 2–3 pounds in 24 hours or 5 pounds in a week can indicate worsening heart failure. Weighing every other day may delay the recognition of fluid overload, increasing the risk of complications such as pulmonary congestion and hospitalization.

C. "I will keep an exercise diary": Regularly tracking physical activity helps assess functional status and detect any decline in exercise tolerance, which could indicate worsening heart failure. An exercise diary allows the healthcare team to adjust activity levels appropriately, ensuring that the client remains active without overexertion. This approach also promotes adherence to a safe and structured exercise regimen, improving overall cardiovascular health.

D. "I will expect swelling in my feet and ankles": While mild peripheral edema can occur, it should never be considered normal in heart failure management. Swelling in the lower extremities suggests worsening fluid retention and should be promptly reported to the healthcare provider. Early intervention, such as medication adjustments or dietary modifications, can help prevent further decompensation and reduce the risk of hospitalization.

A. Born with a high birth weight: Hearing loss is more commonly associated with low birth weight rather than high birth weight. Premature infants or those with complications like neonatal hypoxia are at a greater risk of auditory damage due to underdeveloped structures and increased vulnerability to infections.

B. Frequent exposure to low-volume noise: Prolonged exposure to loud noise, not low-volume noise, is a significant risk factor for hearing loss. High-decibel sounds can cause permanent damage to the cochlear hair cells, leading to sensorineural hearing loss, especially in occupational or recreational settings.

C. Use of a loop diuretic: Loop diuretics like furosemide can be ototoxic, especially when administered in high doses or given too rapidly through IV. They can cause reversible or permanent hearing loss by damaging the stria vascularis of the cochlea, which affects inner ear fluid balance.

D. Chronic infections of the middle ear: Recurrent otitis media can lead to chronic inflammation, scarring, or ossicle damage, resulting in conductive hearing loss. Long-term infections may also cause cholesteatoma formation, which can further impair hearing by destroying middle ear structures.

E. Perforation of the eardrum: Tympanic membrane rupture due to infections, trauma, or barotrauma can lead to conductive hearing loss by impairing sound transmission. While small perforations may heal spontaneously, larger tears might require surgical repair to restore normal hearing function.