A patient with fluid overload is prescribed furosemide (Lasix) 20 mg by mouth each day. What should the nurse include when teaching the patient about this medication? (Select all that apply.)

Choice A: Client is currently prescribed spironolactone is incorrect because spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, or high potassium level, not hypokalemia, or low potassium level. Spironolactone works by blocking the action of aldosterone, which is a hormone that regulates sodium and potassium balance in the body.

Choice B: Client reports drinking 3.5 to 4 L of water each day is incorrect because drinking excessive water can cause hyponatremia, or low sodium level, not hypokalemia. Hyponatremia occurs when the water intake exceeds the water output, diluting the sodium concentration in the blood.

Choice C: Client has an NG tube to gastric suction is correct because gastric suction can cause hypokalemia by removing gastric fluids that contain potassium. Gastric suction can also cause metabolic alkalosis, which is a condition where the blood pH is high and the HCO3 is high, indicating a loss of metabolic acids or an excess of bicarbonate in the body. Metabolic alkalosis can cause potassium to shift from the extracellular fluid to the intracellular fluid, thus lowering the serum potassium level.

Choice D: Client has a history of alcohol abuse disorder is incorrect because alcohol abuse can cause hypomagnesemia, or low magnesium level, not hypokalemia. Hypomagnesemia occurs when there is inadequate intake or excessive loss of magnesium, which is an essential mineral for many enzymatic reactions in the body.

Hypomagnesemia can impair the secretion and action of parathyroid hormone, which regulates calcium and phosphorus balance in the body.

Choice A: Measure body weight every day is correct because body weight is an indicator of fluid balance and can help monitor the effectiveness of the medication. The nurse should instruct the patient to weigh themselves at the same time each day, preferably in the morning, and report any significant changes to the provider.

Choice B: Expect urination to increase is correct because furosemide is a diuretic that works by blocking the reabsorption of sodium and water in the kidneys, thus increasing urine output and reducing fluid volume. The nurse should instruct the patient to drink enough fluids to prevent dehydration and electrolyte imbalance and to avoid taking the medication at night to prevent nocturia and sleep disturbance.

Choice C: Taking the medication before going to sleep is incorrect because taking furosemide at night can cause nocturia and sleep disturbance, as well as increase the risk of falls. The nurse should instruct the patient to take the medication in the morning or early afternoon and to avoid caffeine and alcohol, which can also increase urination.

Choice D: Report swelling of the face or hands is correct because swelling of the face or hands can indicate an allergic reaction or angioedema, which are rare but serious side effects of furosemide. The nurse should instruct the patient to stop taking the medication and seek immediate medical attention if they experience swelling of the face or hands, as well as difficulty breathing, hives, or itching.

Choice E: Expecting to feel weak and dizzy is correct because weakness and dizziness are common side effects of furosemide, especially when starting or increasing the dose. The nurse should instruct the patient to rise slowly from a sitting or lying position and to use caution when driving or performing other activities that require alertness. The nurse should also instruct the patient to report any signs of hypotension, such as fainting, blurred vision, or chest pain.