A nurse working in an alternative therapy clinic is assisting in the care of a client who has elevated cholesterol levels. Which of the following should the nurse recommend?

Rationale:

A. Arterial blood gases: While ABGs assess respiratory and metabolic balance, they are not routinely monitored for clients on furosemide. This test is more relevant for clients with severe respiratory or acid-base disorders, not as a direct indicator of diuretic therapy effects.

B. Blood urea nitrogen: Furosemide is a loop diuretic that can affect kidney function by reducing circulating blood volume. Monitoring BUN helps assess renal perfusion and detect early signs of dehydration or nephrotoxicity associated with diuretic use.

C. Prothrombin time: PT evaluates coagulation status, typically in clients taking anticoagulants like warfarin. Furosemide does not affect clotting pathways, so PT monitoring is unnecessary in this context unless the client is on anticoagulants for another condition.

D. Thyroid stimulating hormone: TSH measures thyroid function but is not influenced by furosemide. There is no established link between furosemide and thyroid activity that would necessitate routine TSH monitoring for clients taking this medication.

Rationale:

• Monitor fetal heart rate: Continuous monitoring is essential after epidural placement to detect changes in fetal status. Minimal variability and early decelerations could indicate emerging fetal distress. Early detection guides timely intervention.

• Assist with administration of ampicillin IV: The client is GBS positive and in active labor with ruptured membranes. IV antibiotics reduce the risk of neonatal infection. Prompt administration is key for prophylaxis.

• Request a prescription for ephedrine: Epidural anesthesia may cause maternal hypotension, which decreases placental perfusion. Ephedrine helps maintain blood pressure. This supports uteroplacental circulation and fetal oxygenation.

• Place the client in left lateral position: This improves uterine perfusion and helps relieve vena cava compression. It is especially important after epidural anesthesia. It also supports better fetal oxygenation during decelerations.

• Decrease the IV flow rate: IV fluids help counteract hypotension that may result from epidural use. Reducing the rate would worsen perfusion and blood pressure. This could compromise fetal oxygen delivery.